V--DC Wheelchair Services

The Washington DC VA Medical Center (DCVAMC) has a requirement for Wheelchair Transportation Services. The contractor shall provide all labor, material, equipment, vehicles, vehicle maintenance, documentation, reports, medical personnel and supervision necessary to provide Wheelchair services for beneficiaries of the DCVAMC and surrounding Community Based Outpatient Clinics (CBOC). Contractor shall furnish vehicles sufficient to provide full and complete coverage for pick-up and/or delivery of all veteran patients requiring transport by wheelchair vans This is a sources sought for the DCVAMC to determine the availability of potential sources (and their size classification relative to NAICS 485999 (Special Needs Transportation) having the skills and capabilities necessary to provide services in accordance with the attached SOW. All interested vendors are invited to provide information to contribute to this market survey/sources sought including, commercial market information. This is not a solicitation announcement. No award will be made from this sources sought. Requested information should be submitted by email to [email protected] by 3:00pm EST May 29, 2014. Provide only the requested information below. REQUESTED INFORMATION STATEMENT OF CABABILITY: Submit a brief [ Five (5) pages or less] capability statement explaining your capability to perform wheelchair transportation services for the DCVAMC. Include past experience in performing these services for the VA, other Government (Federal or State) agency, or for a private medical facility. Please specify your maximum capacity (maximum number of wheelchair vehicles) and your availability to start. Please indicate the distance of your facility from the DCVAMC located at 50 Irving Street NW, Washington, DC 20422. BUSINESS SIZE AND SOCIO-ECONOMIC STATUS: (a) Indicate whether your business is large or small (b) If small, indicate if your firm qualifies as a small, emerging business, or small disadvantaged business (c) If disadvantaged, specify under which disadvantaged group and if your firm is certified under Section 8(a) of the Small Business Act (d) Indicate if your firm is a certified Hub zone firm (e) Indicate if your firm is a woman-owned or operated business (f) Indicate if your firm is a certified Service-Disabled Veteran Owned Small Business (SDVOSB) or Veteran Owned Small Business (VOSB) (g) Include the DUNS number of your firm. (h) State whether your firm is registered with the System for Award Management (SAM) at www.sam.gov and/or the VetBiz Registry at www.vetbiz.gov. If not, please NOTE: any future solicitation could only be awarded to a contractor who is registered in SAM. To receive award based on VOSB or SDVOSB status you must be registered in the VetBiz Registry. STATEMENT OF WORK 1. SCOPE INTENT: The vendor shall furnish wheelchair van transportation to eligible beneficiaries of the Veterans Administration Washington Medical Center (DCVAMC), in strict accordance with all specifications, terms, conditions, provisions, and schedules of this solicitation and any resulting contract document. Such services shall include all labor, supervision, equipment, uniforms, and other items or services necessary for performance of the work. All operations performed shall adhere to VHA Directive 2008-020 (Patient Transportation Program). The contractor(s) shall provide safe and comfortable wheelchair transportation services upon request to or from any pickup points, to or from any floor, ward, nursing home, patient(s) home, medical center, or facility, Monday through Friday, excluding Federal holidays during the hours of 6 AM to 6 PM under direction of the DCVAMC Beneficiary Travel Office or AOD. Occasionally, transportation will be required prior to 6 AM or after 6 PM Monday-Friday, on weekends and Federal Holidays. The DCVAMC will provide the contractor with a minimum of twenty-four (24) hours advance notice of these transportation requirements, which will be reimbursed in accordance with the Schedule of Supplies or Services and Prices/Costs, depending on the current contract period. There may be some instances where 24-hour notice is not feasible and contractor shall make every effort to accommodate these request. 2. APPLICABLE DOCUMENTS DEFINITIONS AND ACRONYMS in use for this Statement of Work (SOW): Administrative Officer of the Day (AOD) - Government employee that is designated for administrative purposes in charge of the Medical Center during other than normal business hours. Wheelchair Van - Vehicles that conform to the United States Department of Transportation (DOT) General Services Administration, transportation Design and Construction Specifications (KKK-A1822, KKK-A-1822E as amended, revised or replaced) that are in effect at the date of vehicle production. Contracting Officer (CO) - Government employee who is warranted by the Government to enter into contracts on behalf of the Government and is the only person authorized to make changes to the contracts. Contracting Officer's Technical Representative (COR) - Individual or individuals designated by the Contracting Officer to place orders, furnish technical guidance, advice, certify invoices, and provides general supervision of the work performed under the executed contract. Department of Veterans Affairs - (VA) Physician - A person who is licensed and legally authorized to practice medicine. Registered Nurse (RN) - A licensed professional with a four-year nursing degree and is able to provide all levels of nursing care including the administration of medication. Washington DC VA Medical Center - (DCVAMC) 3. REQUIREMENTS RATES: Rates are to be based on One-Way Trips. REQUIRED SERVICES: The contractor(s) shall provide safe and comfortable wheelchair transportation services upon request to or from any pickup points, to or from any floor, ward, nursing home, patient(s) home, medical center, or facility, Monday through Friday, excluding Federal holidays during the hours of 6 AM to 6 PM under direction of the DCVAMC Beneficiary Travel Office or AOD. Occasionally, transportation will be required prior to 6 AM or after 6 PM Monday-Friday, on weekends and Federal Holidays. The DCVAMC will provide the contractor with a minimum of twenty-four (24) hours advance notice of these transportation requirements, which will be reimbursed in accordance with the Schedule of Supplies or Services and Prices/Costs, depending on the current contract period. There may be some instances where 24-hour notice is not feasible and contractor shall make every effort to accommodate these request. FIRST AID - All Contractor's drivers shall have passed a basic First Aid Course and have on file a current certificate to be available to the Contracting Officer upon request. ADULT CPR - All Contractors' drivers shall have passed an Adult CPR Course and have on file a current certificate to be available to the Contracting Officer upon request. RESPONSE TIME: In most cases, transportation requests will be made twenty-four (24) hours in advance or by 4:30 pm, the day prior to the trip; however, the Contractor must be able to accept requests for same day service and to schedule them in a manner that meets the arrival time needs for medical appointments, etc. Patients waiting return transportation will be picked up within forty-five (45) minutes of telephonic notification that the patient's visit is completed. The Contractor shall furnish and dispatch required service within forty-five (45) minutes immediately after receiving a wheelchair van request or an order from the VA. The VA reserves the right to obtain the service from another source, and to charge the Contractor with any excess cost which may result therefore. The VA will be the sole judge in determining when to order service from another source. Failure to pick-up or to deliver a patient within (30) minutes of the allowed times shall result in a payment deduction of one-fourth (1/4) of the applicable charges for the trip for each thirty minutes the contractor is late. After the first thirty (30) minutes, for each fifteen (15) minute portion added to the thirty minutes, the charge will be one-eighth (1/8) of the applicable charges. The Contractor shall be charged additionally for instances where such failures cause a patient to miss an appointment. The Contracting Officer (CO) and the Director, Business Office shall make determination of appropriate charges. The assessment of charges, for each occurrence, shall be based upon the cost of the missed appointment to include treatment cost and any indirect administrative charges the VA incurs in rescheduling the appointment. It shall be the responsibility of the Contractor's representative to immediately notify the VA ordering office (Travel Clerk) when unable to make a pick-up or delivery by the exact time specified for previously scheduled trips; or unable to dispatch a wheelchair van to a designated pickup point within the required time frame for unscheduled request for services. The notification shall include the reason for the delay and whether the pick-up or delivery can be made at a later time and if so, at what times. It shall be the sole discretion of the VA ordering office (Travel Clerk) to decide: 1) to accept the later pick-up or delivery time, and based upon reason for the delay, present the delay for payment reduction; or 2) refuse the later pick-up or delivery time, order the services from another source, (the applicable order office (Travel Clerk) shall be the sole entity for determining when to request the services from another source), and present the reason for delay, to the Contracting Officer, as a occurrence that may be subject to default. Further, based upon the reason for the delay, the Contractor may be charged with excess cost incurred by the VA in ordering the service from another source. For the purpose of this contract, "excess cost" is the difference between prices charged by another source used and the applicable contract prices. During a six (6) month period: 1) one avoidable delay longer than thirty (30) minutes, 2) two (2) consecutive delays regardless of duration; 3) a total of two (2) delays resulting in any patient missing an appointment; 4) two (2) failures to meet the required dispatch times; or 5) any combination of two (2) of the aforementioned incidents, may be subject to the provisions of default. This determination will be made by the Contracting Officer. Failure to meet response times that are caused by the patient, the patient's family, VA personnel, and medical emergency while enroute, or other causes beyond the control and without negligence of the dispatcher or the transportation attendant, will not be held against the Contractor. Should such incidents occur, and if possible, the transportation attendant shall notify-the VA ordering office (Travel Clerk) and shall document the circumstances on the trip ticket. NUMBER OF PATIENTS: It is understood and agreed that only one (1) patient will be transported on a trip unless specifically authorized by the VA. When, pursuant to VA authorization, more than one patient is transported concurrently on a trip, reimbursement shall be made at the rate not exceeding the cost of transporting a single patient. Authorization will be granted only for the convenience of and at the discretion of the VA. Vehicles transporting VA beneficiaries will be dedicated exclusively to VA transports. The Contractor may not carry non- VA contract beneficiaries or private pay patients with VA beneficiaries. CHECK-INS: Drivers shall identify by use of log in/log out sheets the patients being transported to and from the DCVAMC as required by the Government. Drivers transporting patients must either wear uniforms or other form of easily identifiable insignia, which identifies the person as an employee of the Contractor. Drivers must maintain accepted standards of cleanliness and grooming and demonstrate courtesy of the patients being transported. SMOKING: No Smoking is allowed by Contractor personnel or patients while providing services under this contract. PERFORMANCE: Contractor performance shall be in strict accordance with the contract and all applicable Federal, State, and local laws. WAITING TIME: For time lost in waiting at either end or both ends of a trip due to causes beyond his control, the Contractor will be reimbursed at the rates of one-fourth (1/4) the hourly rate quoted by his bid for each quarter hour, or fraction thereof, in excess of forty-five (45) minutes waiting time, from the time he reports to the designated person. If the pick-up is other than at the VA Medical Center (VAMC), the Contractor shall call the Travel Clerk during regular working hours and the Medical Administrative Assistant after regular working hours as soon as he anticipates that a delay may develop for which he expects to claim reimbursement. This call is only for the purpose of verifying his arrival time at the pick-up point and is not necessary if the Contractor anticipates no delay for which he will claim reimbursement. Invoices must list all waiting costs by patient's name, date and time (i.e. arrival time, time reported to designated person, and time Contractor left the facility). ORDERS: Requests for services will be made in writing or by telephone 24 hours per day, 7 days per week, and subsequently confirmed in writing by Medical Administration Service. If the Contractor fails to furnish the required transportation service to the pick-up point within the forty-five (45) minutes after receiving a request or any order, the VA reserves the right to obtain the service from another source and charge the Contractor any excess cost which may result there from. The VA shall be the sole judge in determining when to order service from another source. Wheelchair vans shall be required to transport patient's belongings, wheelchairs, or medications with the patient. CANCELLATION OCCURRENCE: Those occasions when a non-scheduled request is made from an authorized VA ordering office and is for dispatch of an transport but is cancelled by that office within 15 minutes of the request. There shall be no charge for any cancellation that is made within the 15-minute time period. The cost for a cancellation not made within the 15- minute time period shall be at one-fourth (1/4) of the charges that would have occurred had the trip been completed. NO PICK-UP: Those occasions when an wheelchair van is dispatched in response to an authorized VA ordering office schedules or non-scheduled request and upon arrival at the pick-up point no patient transport is effected, for reasons other than those caused by the Contractor. The cost for a no pick-up shall be a one-fourth (1/4) of the charges that would have occurred had the trip been completed. TOLL CHARGES: It is agreed and understood that the prices quoted in the schedule do not include any ferry, bridge, tunnel or road toll charges. Any such legitimate toll charges incurred shall be limited to "ONE WAY ONLY" and shall be listed separately on the Contractor's invoice, and substantiated with original receipts. USE OF SUB CONTRACTORS: The contractor is free to subcontract service in order to satisfy the VA's requirements. All companies utilized as subcontractors are subject to approval of the VA and must meet all requirements of this contract. The contractor shall disclose use of any subcontractors and ensure all certification and training requirements are in compliance with federal, state, and county regulations governing transportation services. The contractor shall be responsible for all subcontracting services provided under this contract. Subcontractor's invoices shall not be submitted directly to the VA, but rather shall be incorporated as part of the prime contractor's regular monthly invoicing. VEHICLE: Each vehicle must be equipped at all times during performance as required by Federal, State, and local laws, ordinances, codes, rules or regulations. Vehicles must be capable of 1) providing access to wheelchair patients unable to transfer from their wheelchair to a vehicle without assistance and 2) provide access to stretcher bound patients unable to transfer to a sitting position. The wheelchair vans under the terms of this contract shall be licensed and must meet the minimum vehicle requirements as mandated by the Maryland Department of Health, Bureau of Emergency Medical Services. All vehicles must meet or exceed the minimal specifications. All vehicles shall have restraints for securing wheelchairs. WHEELCHAIR TRANSPORT EQUIPMENT: Each vehicle shall be equipped at all times when transporting a patient in the performance of this contract with equipment as required by Federal, 49 CFR Parts 27, 37 and 38, Transportation for Individuals with Disabilities (most current volume), State and Local laws, ordinances, codes, rules of regulations. MAINTENANCE OF VEHICLES, SUPPLIES AND EQUIPMENT: The vehicle(s), to include supplies and equipment, shall be maintained in a manner so as to assure safe quality medical transportation and, if needed, emergency medical care. Standards for maintenance, safe transportation, and emergency medical care shall be based upon those dictated by the vehicle manufacturers recommended maintenance procedures, the industry safety standards, and those procedures and directives defined in the Contractor's Medical Treatment Protocol. At a minimum, the VA requires a daily, monthly, semi-annual and annual vehicle maintenance and inventory inspection. Daily the vehicle shall be checked for its operational condition, i.e., tire pressure, functional lights, oil level, etc. and inventoried for proper equipment and supply levels. Monthly, semi-annual, and annually, the vehicle shall be checked using the manufacturer's recommended preventive maintenance inspection procedures. Supplies shall be checked for sterility, level compliance and to ensure, as applicable, that instrument, fluids, medications, etc., are not out-dated. Documentation of inspections and inventories, to include comments of any action taken to correct discrepancies, shall be retained for a period of no less than thirty (30) days. Should it be requested, the inspection and inventory data shall be available for review by the Contracting Officer and/or COR. GOVERNMENT OWNED EQUIPMENT/SUPPLIES: Any and all equipment, machinery, lines, etc. taken with patients must be returned. The Contractor must provide his own linens and must not be exchanged with VA linens. Any vendor not in compliance linen costs will be deducted from invoice. INSPECTION: The right is reserved to thoroughly inspect and investigate the establishment, facilities, business reputation, and other qualifications of any bidder and to reject any bid, irrespective of price, that shall be administratively determined lacking in any of the essentials necessary to assure acceptable standards of performance. If any vehicle equipment is added after inspection, subsequent to award of contract, it shall be inspected and approved by the Contracting Officer or the COR before being placed in use under this contract. Inspection of Contractor's Equipment: The Contracting Officer reserves the right to inspect the equipment the bidder proposes to use in the performance of the contract, prior to award of the contract. Upon request, bidders will promptly furnish to the Government a statement of bidder's previous experience, organization (including company officers), technical qualifications, financial resources, and facilities available to perform the work under this contract. ATTENDANTS: Record of each employee as to character and physical capabilities of performing the duties of a wheelchair transport driver or attendant must be maintained and made available for inspection upon request by the VA. QUALIFICATIONS: Offers will be considered only from bidders who are regularly established in the business called for and who are financially responsible and have the necessary equipment and personnel to furnish service in the volume required for all the items under this contract. Successful bidders shall meet all requirements of Federal, State, or City codes regarding operations of this type of service. Each bidder must submit, along with a bid, a letter in duplicate fully describing the make of the vehicle, model, and year which he agrees to furnish under this proposal, including the location and telephone numbers of his establishment where calls are received and vehicles are immediately available for dispatch. The Contracting Officer shall be notified in writing of any transportation equipment added after award of the contract. DRIVERS: All Contractors drivers shall have passed a basic First Aid Course and have on file a current certificate to be included with offerors technical proposal. During contract performance, documentation must be made available to the Contracting officer upon request. All contractors shall have passed an Adult CPR/First Aid course and have on file a current certificate to be available upon request. All Contractors drivers shall be required to wear, in a readily observable area o the employee, a Contractor supplied photo identification badge containing the name of the driver, and the Contractors business name, or company uniform that is acceptable to the Contracting Officer. All Contractors' drivers shall maintain a valid license to operator the type of vehicle necessary to perform the service, as required by the District of Columbia. Copies to be included with offerors technical proposal of all drivers performing under this contract. All Contractors' drivers shall have the physical capabilities to provide special assistance to the patients when transporting patient s to the medical center, university hospital, private residence, nursing homes, etc. The Contracting Officer reserves the right to prohibit specific drivers from participating in the loading, transporting and unloading of patients should it be determined the driver has engaged in unsafe practices. NON-EMERGENCY ATTENDANT-DRIVER(S): Prices include non-emergency medical technicians and/or drivers as appropriate. Technicians and drivers must be capable to administer oxygen and have successfully completed the Standard and Advanced First Aid Courses of the American Red Cross of the U.S. Bureau of Mines, or equivalent. Proof in the form of a current certificate that such first aid training has been successfully completed must be available upon request. An authorized official of the Department of Veterans Affairs may, in the best interest of the beneficiary, allow a relative to accompany him/her. EVIDENCE OF INSURANCE COVERAGE: Before award of contract, the contractor shall furnish to the Contracting Officer, a certificate of insurance which shall contain an endorsement to the effect that cancellation of, or any material change in, the policies which adversely affect the interests of the Government in such insurance shall not be effective unless 30-day written notice of cancellation or change is furnished to the Contracting Officer. PAYMENTS: Payments will be made in arrears upon receipt of a properly prepared invoice in accordance with FAR Clause 52.212-4(g)(1). Invoice shall be itemized with patient's full name, date of service, pick-up point and destination and any approved additional charges such as tolls, oxygen or billable waiting time, and the contract number. OPTION YEARS: The Contractor is notified that Option Years are not automatically renewed. The Contracting Officer may renew option years in accordance with FAR Clause 52.217-9, Option to Extend the Term of the Contract. REGISTRATIONS: Each contractor is required to register with the NIH CPS database at the following web address: https://cpscontractor.nih.gov, if you need assistance, please contact the CPS Support via email at cps-support-lAlist.nih.gov or call 301-451-2771. The Contracting Officer will evaluate the contractor's performance annually. The report shall be assigned in CPS to the contractor's designated representative for comment. The contractor representative will have thirty (30) days to submit any comments and re-assign the report to the VA Contracting Officer. Failure to register and respond within the thirty days will result in the Government's evaluation being placed on file in the database with a statement that the contractor failed to respond. System Award Management (SAM): SAM require that federal contractors register in the System Award Management database at http://www.sam.gov and enter all mandatory information into the system. Award may not be made until the contractor has successfully registered. Offerors are encouraged to ensure that they are registered in CCR prior to submitting their offer. INCIDENT-ACCIDENT REPORTS: In the event that the Contractor is involved in any incident or accident while transporting a VA patient, regardless of how minor the incident/accident appears to be, verbal notification with all the facts as they relate to the incident/accident shall be reported to the COR, AOD, or CO. This notification shall take place once the medical necessity or crisis has ended. A written report shall be submitted to the CO within forty-eight (48) hours of the incident/accident with a list of the contractor staff names (drivers/attendants), patient name(s), any pertinent information and witnesses. PATIENT CONFIDENTIALITY: Contractor shall insure the confidentially and security of all patient information and shall be held liable in the event of breach of confidentiality. The contractor shall comply with the provisions of the Privacy Act (5 USC 522a), Confidentiality of Drug Abuse, Alcohol Abuse, Sickly Cell Anemia, and HIV/AIDS Treatment Records (38 USC 7332 and 38 USC 4132) and Confidentiality of Medical Quality Assurance Records (38 USC 5705 and 38 USC 3305). The contractor shall comply with all pertaining to confidentiality and security statutes. The contractor shall be Health Insurance Portability and Accountability Act (HIPAA) compliant. Failure to comply with statues regarding confidentiality and security of patient health information/individually identifiable information may result in financial sanctions. In addition, all patient charts and records transported with the patient are confidential and limited to a "need to know" basis for the Contractor's personnel. Appropriate administrative and medical information will be provided to the Contractor for patient transport. If the medical record is transported with the patient, it may be used as a source of information if the situation warrants. In all other instances, all documents will remain intact and secured. CONTRACTOR OPERATIONAL REQUIREMENTS: All wheelchair vans used in conjunction with this contract shall meet or exceed all current City, County, State, and Federal regulations as they pertain to the requested services under this contract. Wheelchair vans shall be well maintained and in a constant state of readiness throughout the life of this contract. Maintenance records, Certifying Agency or Agencies inspections and other pertinent records shall be presented to the CO upon request. Wheelchair vans shall be clearly marked (identifiable) for the purpose they are to perform. The exterior shall be kept neat and professional in appearance. Interior shall be kept orderly, clean, and professional in appearance and in an organized manner. All wheelchair vans while performing services under this contract shall meet or exceed all current City, County, State, and Federal regulations as they pertain to the qualifications and staffing levels of the personnel aboard. The Government reserves the right to refuse/dismiss any vehicle from providing services under this contract. CONTRACTOR PERSONNEL: Contractor personnel assigned to perform services under this contract shall meet or exceed all current City, County, State, or Federal licensures, certifications, and training relative to the function they are to perform under this contract. Minimally, included, would be re-certification(s), continuing education and/or refresher courses. These requirements shall be maintained current throughout the life of this contract. Personnel's certifications and documentations shall be presented to the CO upon request. Contractor personnel shall wear a company uniform with the employee's name readily visible on the outside of the uniform, while performing services under the contract. This can be a legend on a uniform or uniform jacket or by means of a name badge or a combination of both. Uniforms shall be clean and maintained, in good repair to present a professional image. The Government reserves the right to refuse/dismiss any personnel from providing services under this contract. The parties agree that such personnel shall not be considered VA employees for any purpose and shall be considered employees of the Contractor. QUALIFICATIONS OF OFFERORS: Proposals shall be considered only from offerors who are regularly established in the business called for, who in the judgment of the CO are financially responsible and have the necessary equipment and personnel to provide the service specified herein, and who meet all Federal, State, or local codes or regulations regarding operations of transportation Service. The VA reserves the right to thoroughly inspect and investigate the establishment, facilities, business reputation and other qualifications of any bidder and to reject any bid, irrespective of price, that shall be administratively determined lacking in any of the essentials necessary to assure acceptable standards of performance. If any transportation equipment is added after inspection, subsequent to award of contract, it shall be inspected and approved by the CO being placed in use under this contract. SCHEDULING OF WORK: The COR, AOD, CO and designees only are authorized to place requests (orders) for contract services with the Contractor's dispatch office. The request for services shall specify the originating point and final destination. Only such travel is authorized and any costs incurred for unauthorized travel, stops, waiting times, etc., will be the responsibility of the Contractor. The Contractor is cautioned that performance of a trip or substitution of type of vehicle at the request of others, without approval of appropriate authorized personnel, may be deemed as unauthorized travel for which the Contractor may bear the risk of non-reimbursement. NATIONAL HOLIDAYS: Wheelchair services shall be available upon request twenty-four (24) hours a day, three hundred sixty-five (365) or sixty-six (366) days per year, including all National Holidays. National Holidays are: New Year's Day Martin Luther King's Birthday President's Day Memorial Day Independence Day Labor Day Columbus Day Veterans Day Thanksgiving Day Christmas Day Note: Also included would be any other day specifically declared by the President of the United States to be a National Holiday. Office of Inspector General of the Department of Health and Human Services (OIG/HHS) has made a determination that prior to obligating VA contracts, purchase orders, task and delivery orders, and any purchase card orders paid with VA health care funds may not be entered into with any individual; entity or organization that has been listed on the OIG/HHS Exclusionary List. VA does not have the burden of defending the merits of the OIG/HHS decision established under 42 USC 1320a-7. 4. NOTES HIPAA COMPLIANCE: HIPAA compliance is required. The Contractor must adhere to the provisions of Public Law 104-191, Health Insurance Portability and Accountability Act (HIPAA) of 1996 and the National Standards to Protect the Privacy and Security of Protected Health Information (PHI). As required by HIPAA, the Department of Health and Human Services (HHS) has promulgated rules governing the security and use and disclosure of protected health information by covered entities, including the Department of Veterans Affairs (VA). In accordance with HIPAA, the Contractor may be required to enter into a Business Associate Agreement (BAA) with VA. VACO has recognized transportation service as an entity that does not require a BAA with their contractors as long as they are conducting health care on behalf of the VA - ground transportation program qualified as a medical service - therefore, no BAA is required.