Q402--Intent to Sole Source to CNH Sierra Care at the Lakes
NOTICE OF INTENT TO SOLE SOURCE Department of Veterans Affairs (VA) Network Contracting Office (NCO 21) intends to award a sole source, firm fixed price with economic price adjustment, indefinite-delivery-indefinite-quantity contract to Sierra Care at the Lake. There is currently one Veteran at the facility, and the current contract expires 05/31/2020. All responsible sources may submit a may capability statement, proposal, or quotation by March 27, 2020 no later than 11:59 PM PST which shall be considered by the agency. As prescribed in VHA Handbook 1143.2, for more than 35 years the CNH Program has maintained two cornerstones: some level of patient choice in choosing a nursing home close to the veteran s home and family, and a unique approach to local oversight of CNHs. In light of this Program, the VA does not intend to move the Veterans or disrupt their care. A Justification and Approval (J&A) will be executed by the Head of the Contracting Activity (HCA) for the contract and will be posted to www.fbo.gov as required by Federal Acquisition Regulation (FAR) 13.01(a)(1)(iii). Period of Performance: June 01, 2020 tough May 31, 2025 Contractors shall complete the Price-Cost Schedule for the purpose of market research. Contractors shall provide sufficient data showing they have previously performed the required services identified in the Performance Work Statement (PWS). Contractors shall provide sufficient data showing that they can meet all of the requirements listed within the PWS. PRICE SCHEDULE Contractor shall provide Nursing Home Care services for eligible Veterans at contractor s place of business within the Fresno, CA area. All services shall be provided in accordance with the specifications, terms and conditions contained herein. The guaranteed minimum, for the contract is one room for one veteran for one day. The maximum of the contract, inclusive of ordering periods, shall not exceed $3,000,000.00. The Government does not guarantee that it will place any orders under this contract in excess of the guaranteed minimum award amount. (NOTE: The reference to the published rate means the date the rates are published and distributed, not the effective dates. In other words, if the rates are effective August 1, but they are not published until the subsequent March, then the rates for this contract would change in March.) PERIOD OF PERFORMANCE: June 01, 2020 tough May 31, 2025 ITEM NUMBER DESCRIPTION OF SUPPLIES/SERVICES UNIT PER DIEM RATE 0001 BED HOLD (State Medicaid Daily Rate = VA BASE) DY Reimbursed at Current State Medicaid without Supplement 0002 RESPITE (State Medicaid Daily Rate = VA BASE) DY Reimbursed at Current State Medicaid without Supplement 0003 HOSPICE CARE DY Reimbursed at Current State Medicaid daily rate plus ___% 0004 REDUCED PHYSICAL FUNCTION, BEHAVIOR & COGNITIVE PERFORMANCE DY Reimbursed at Current State Medicaid daily rate plus ___% 0005 CLINICALLY COMPLEX DY Reimbursed at Current State Medicaid daily rate Plus ___% 0006 SPECIAL CARE HIGH DY Reimbursed at Current State Medicaid daily rate Plus ___% 0007 SPECIAL CARE LOW DY Reimbursed at Current State Medicaid daily rate Plus ___% 0008 EXTENSIVE SERVICES DY Reimbursed at Current State Medicaid daily rate Plus ___% 0009 REHABILITATION DY Reimbursed at Current State Medicaid Plus ___% 0010 REHABILITATION + EXTENSIVE SERVICES DY Reimbursed at Current State Medicaid daily rate Plus ___% PERFORMANCE WORK STATEMENT Federal Acquisition Regulation (FAR) Indefinite Delivery Contract (IDC). In accordance with FAR 16.504, Indefinite-Quantity Contracts, this is a IDC from the Award Date for five (5) years plus four (4) ordering periods to be exercised at the sole discretion of the Government. Services Rendered at VA Per Diem Rates. Upon acceptance of a VA patient by the CNH, if and when requested by the VA Contracting Officer or authorized representative, the Contractor shall furnish all supplies and services herein described, at the per diem rates for the Levels of Care specified in the Schedule of Items of this IDC. The VA Levels of Care are defined in an attachment in Section D.1 of the solicitation and the IDC. VA is obligated only to the extent authorized placement of patients is made in accordance with this IDC and related task orders issued under this IDC. Ordering. Task Orders will be issued by the cognizant Contract Administration Office identifying specific cost limitations and periods of performance prior to placement of any task orders under this IDC. Orders will be issued by Ordering Officers to place Veterans in Nursing Homes, often on a sole source basis using an Exception to Fair Opportunity and utilizing the CPRS system at VA hospital sites (Reference FAR 16.505 (b)(2)(i)(B)). Ordering Officer Contact information is as follows: Ordering Officer Name: To be determined after award Address Telephone number E-mail address Facsimile number Agency task and delivery order ombudsman (see 16.505(b)(8)) if multiple awards may be made. Background/Introduction. The Community Nursing Home (CNH) program is a key component of the Veterans Health Administration (VHA) continuum of care. The Contractor agrees to provide in accordance with the terms and conditions stated herein to the U.S. Department of Veterans Affairs Central California Health Care System (VACCHCS), at the prices specified in the section titled Schedule of Services and Price of this IDC. Nursing home facilities in the CNH program shall cooperate with VA staff in referral of appropriate veterans for care and accept veterans of which they have the capability/capacity to care. The term, facilities, shall include but not be limited to rooms, wards, sections, eating areas, drinking fountains, entrances, and other like areas. VA shall have the right to inspect the CNH and all appurtenances by authorized VA representative(s) to ensure that acceptable standards are maintained and that the necessary care to maintain the well-being of the patient is rendered. Requirements General. Nursing home facilities in the CNH program shall ensure that care meets the health needs and promotes the maximum well-being of VA beneficiaries. Nursing home care will be furnished based on an interdisciplinary assessment to ensure the total medical, nursing, and psychosocial needs of VA beneficiaries are being met. Full attention shall be given to motivating and educating patients to achieve and maintain independence in the activities of daily living, to the maximum extent possible. Every effort shall be made to keep Veterans ambulatory, while achieving an optimal level of self-care and to coordinate discharge arrangements when clinically appropriate. All nursing home facilities in VA s CNH program must have the following: Current and unrestricted Center for Medicare and Medicaid Services (CMS) certification (Medicare and/or Medicaid) Current and unrestricted State/Federal nursing home licensure and certification Liability insurance must be maintained and available for review VA has developed quality of care standards utilizing CMS inspection criteria which is followed by VA CNH Program Coordinators or other VA authorized designees during the process of selection and approval of nursing homes. See VHA Handbook 1143.2, VHA Community Nursing Home Oversight Procedures (June 4, 2004) a copy of which is available at: http://www.va.gov/vhapublications/publications.cfm?pub=2. VA CNH Program often has a particular need for specialty level of care services. The VA requires CNHs to have bed capacity and capability to accept VA authorized referrals in a timely fashion (ideally within 24 hours of request). Provider visits will be available at the rate of one (1) visit per month; other services such as laboratory, x-ray, and other special services will be available to VA patients as needed. Additionally, inclusive authorization of care provided without extra charge will include the following: room, medications, meals, nursing care, provider visits as needed and other services/supplies commensurate with the VA-authorized level of care, as specified in the Schedule of Items of this IDC. Duly authorized representatives of VA will conduct visits to the CNH in order to provide continuity of care and quality oversight VA placed veterans and to assist in the veterans transition back into the community. These visits do not substitute nor alleviate the CNH s contracted responsibility for the daily care and medical treatment of the veteran. The per diem rate(s) established in this IDC will include the cost of primary medical care, at a minimum one (1) provider visit per month (including needed consultation, medications and routine supplies, laboratory, x-ray, and other VA authorized specialty services, unless otherwise and specifically excluded). See the Schedule of Items for details regarding the per diem rates, inclusions and exclusions. Every effort will be made to help patients achieve and maintain the highest possible quality of life. CNH staff shall direct their full attention to keeping the patients ambulatory as well as educating and motivating patients to achieve and maintain independence in the activities of daily living (ADL) as well as the optimal level of self-care. Termination of Services. VA reserves the right to remove any or all VA patients from the CNH at any time when it is determined to be in the best interest of VA or the patients without additional costs to the Government. VA Authorizations. Authorization for nursing home care will be submitted on VA Form 10-7078, Authorization and Invoice for Medical and Hospital Services. Each authorization validity period will be noted on the VA Form 10-7078 with a beginning and end date as well as the specific level of care authorized. Any/all adjustment(s) to the period of approval or changes in the level of care must be specifically requested and written approval/authorization (a new VA Form 10-7078) must be received prior to services being rendered. Rates: Medicare-Based Rates. The Resource Utilization Grouping (RUG) rate(s) is all-inclusive rate(s) which include the following costs: room, meals, medications, medical care, wound care, physician visits, laboratory, x-ray, therapy (ies), equipment, supplies and other special services authorized by VA, unless otherwise specifically excluded. VA will contract for appropriate Medicare categories of care using Resource Utilization Groups (RUGs-IV) as a reference and prior written approval for specific RUG Levels of Care are required. A description of the RUGs-IV systems can be found in 42 CFR Parts 409, et al. Medicare Rate Determination. The per diem rate is established by the current Medicare rate for Medicare- approved nursing homes including the cost of supplies, services, and equipment above that provided under Medicare. The CNH vendor shall validate established rates prior to submitting invoices for services provided. In the event established rate changes are not published timely, the CNH vendor shall submit an invoice for the difference within thirty (30) days of the published rate change to include any retroactive amount due. CNH vendor is not entitled to interest accrual in such cases unless payment is not disbursed in accordance with 52.212-4(i) of this IDC. The RUGS IV rates include room, meals, routine nursing, medical and wound care, physician visits, laboratory, x-ray, rehabilitation therapy (including physical, speech and occupational), respiratory and oxygen therapy, medical and nursing supplies (including items such as urological and colostomy supplies), items of durable medical equipment (excluding ventilators), and other special services authorized by the VA unless otherwise specifically excluded. Any and all adjustment(s) to the RUG level of care or additional requests for payment to the all-inclusive per diem rate must be specifically requested and written approval/authorization must be received prior to services being rendered. The CNH s Minimum Data Set (MDS) Assessment for Medicare: The CNH s Minimum Data Set (MDS) assessment will be completed on the same schedule as the current Medicare MDS-Scheduled assessments, including close of therapy (COT) assessments. Classification changes will be approved by VA, dependent on projection for short-term or long-term residence, and adhering to the most current MDS frequency guidelines from Medicare. The applicable per diem rate will continue until the next assessment. Any and all adjustment(s) to the RUG level of care or additional request for payment to the all-inclusive per diem rates must be specifically requested and receive written approval/authorization for a specific period of time and prior to services being rendered. VA will make the determination whether classification changes require readmission to VA. VA staff will audit MDS assessments as needed, as determined by the VA. The Level of Care classification and associated per diem rates will remain in effect for each placement until and unless one of the following events takes place: Re-hospitalization that may be associated with a change in level of care; Need for more intensive therapy; Significant change in condition; or Classification changes may also occur based on a determination by VA. Medicaid-Based Rates. The current State Medicaid rates shall be used as a basis for determination of VA rates. The VA rate will include medical care, routine medications, laboratory, x-ray, therapy (ies), and other special services authorized by VA, unless otherwise specifically exempted. VA will contract for appropriate Medicaid categories of care using Resource Utilization Groups (RUG-IV) as a guide. As with Medicare, a description of the RUG-IV systems can be found in 42 CFR Parts 409, et al. Primary Medical Coverage. The assigned CNH provider is the primary medical provider during the nursing home stay and is responsible for writing or approving admission and all other orders from the time the veteran arrives at the CNH. The CNH provider is responsible for general medical care, urgent evaluation and intervention, according to OBRA guidelines (42 CFR 483.40). Provider visits will be according to the Center for Medicare and Medicaid Services (CMS) guidelines. The assigned nursing home provider will provide timely care following the most current CMS guidelines; arranging 24/7 access for patient care; arranging easy access to VA staff for consultation; providing timely response to calls and arranging for timely provider back-up according to OBRA guidelines (42 CFR 483.40, OBRA Guidelines). Rehabilitation Criteria. All therapy provided under this IDC will be individual therapy, rather than group therapy, unless otherwise ordered by the authorizing VA facility. Therapy may require pre-approval by VA before services are provided. Medical Restorative criteria will be used for physical therapy, occupational therapy, and speech therapy. Therapy must be skilled, relate to safety and be restorative according to Medicare criteria. Description of Rehabilitative Therapy. The concept of rehabilitative therapy includes recovery or improvement in function and, when possible, restoration to a previous level of health and well-being. Therefore, evaluation, re-evaluation and assessment documented in the Progress Report should describe objective measurements which, when compared, show improvements in function, or decrease in severity, or justification for an optimistic outlook to justify continued treatment. Covered therapy services shall be rehabilitative therapy services unless they meet the criteria for maintenance therapy requiring the skills of a therapist. Evaluations/re-evaluations should consider the following: Establishment of treatment goals specific to the patient s disability or dysfunction and designed to specifically address each problem identified in the evaluation; design of a plan of care addressing the patient s disorder, including establishment of procedures to obtain goals, determining the frequency and intensity of treatment; continued assessment and analysis during implementation of the services at regular intervals; instruction leading to establishment of compensatory skills; selection of devices to replace or augment a function (e.g., for use as an alternative communication system and short-term training on use of the device or system); and patient and family training to augment rehabilitative treatment or establish a maintenance program. Education of staff and family should be ongoing. Emergency Care; Financial Responsibility; Advanced Directives. In emergencies, CNH staff will utilize the 911 local emergency systems as for any resident. The Nursing Home must contact the VA CNH Coordinator or VA authorized representative upon transfer of the contracted Veteran to an outside facility and provide at a minimum, the following information: Identifying information of Veteran; Date of transfer; Reason for transfer and the transfer location. Advance directives or living wills shall be adhered to according to CNH physician s orders. When private hospitalization or emergency services are required, the patient, spouse, financial guardian or insurer is financially responsible. Service connected veterans may qualify for VA coverage of emergency care provided the VA Health Care System (VAHCS) is contacted by the private hospital provider within 72 hours of admission on the first business day following a weekend or holiday. This includes the cost of necessary transportation for such care. 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, but VACO has recognized CNH Facilities as an entity that does not require a BAA as long as they are conducting health care on VA s behalf. The CNH care program qualifies as a medical service, so no BAA is required. State Licensure; Access to CNH Quality of Care Reports (QASP Indicator #1). The CNH must maintain a current and unrestricted state license to operate as a skilled nursing facility. Changes in the status of the licensure will be immediately reported to the VANCHCS CNH Program Coordinator or VA authorized representative. VA will monitor the professional care and administrative management of services provided to VA beneficiaries under this IDC, tough one or any combination of the following methods: reviews of State agencies reports; on-site inspection of the CNH by VA staff; and/or on-site monitoring of VA patients. The CNH shall provide VA with copies of all State agency reports when requested, and cooperate fully with VA s quality improvement and/or quality assurance program functions relating to this IDC, including VA s on-site inspection and monitoring. The VA Contracting Officer or VA authorized representative shall make all final determinations as to the Contractor s reasonable cooperation with VA and compliance with these requirements. Corrective Action Plan (QASP Indicator #2). The CNH will cooperate with timely development of Corrective Action Plans (CAPs) related to identified deficiencies and related to State, Federal or VA surveys. The CNH will develop in the time period specified by VA timely and appropriate CAPs for VA surveys or investigation of complaints related to quality of care or sentinel events. The CNH will also supply related documents or data as specified by VA. The CAPs will include but are not limited to the following criteria and shall: contain elements detailing how the CNH will correct the deficiency as it relates to the identified deficiency(ies); indicate how the CNH will act to protect residents in similar situations; Include the measures the CNH will take or systems that will be altered to ensure that the problem will not recur. It is the CNH s responsibility to evaluate the system and determine if a change to the existing system will work, if a new system is necessary, or if a system does not currently exist and must be developed; Indicate how the CNH plans to monitor performance to make sure that solutions are permanent. The CNH must develop a quality assurance tool for ensuring that correction is achieved and sustained. This tool must be implemented. Failure to implement a quality assurance tool to sustain compliance will reflect that the CNH has an ineffective quality assurance system; and Provide dates when corrective action will be completed. Life Safety Code. The CNH s building shall conform to the most recent standards of the Life Safety Code (National Fire Protection Association Standard No.101) in effect on the date of the IDC award and compliance with all applicable Federal, State and local regulations. The administrator of the CNH is required to notify the VA Contracting Officer or other VA authorized representative in writing at least thirty (30) calendar days prior to any planned facility changes that could impact the Life Safety Code and other safety features of the facility which were in existence at the time this IDC became effective. The VA Contracting Officer or other VA authorized representative will notify the VA Safety Manager responsible for the Life Safety Code inspection of the CNH and will review (inspect the facility if required) the proposed changes and provide necessary approval/disapproval of the CNH to house veterans during and/or after the proposed changes. These changes may include but are not limited to: Interior changes requiring VA approval. Some examples of facility changes that require the VA Contracting Officer notification are as follows: interior finish, corridor partitions/walls, patient room doors, linen or trash chutes, exits, emergency lighting, fire alarm systems, automatic sprinklers, smoke barrier walls or doors, oxygen systems, compressed gas storage, HVAC, electrical and fuel gas systems; Automatic sprinkler system. All VA contracted CNH facilities are to be fully-equipped with a fully-automatic sprinkler system installed in accordance with the National Fire Protection Association s (NFPA) standards and be 100% sprinklered; Natural disasters. In the event of a natural disaster (flood, tornado, etc.), the CNH shall communicate all action plans to VA. The action plans will at a minimum identify temporary transfers of location, dates, and names of veterans transferred; and Major construction; additions; and renovations. Major construction including building additions or other renovations which may affect physical plant integrity; SHALL MEET latest NFPA 101 Life/Safety Code requirements as well as any additional VA CNH construction standards in place at the time of renovation or alteration. Acceptable Safety and Sanitation Practices. Acceptable safety and sanitation practices shall be observed toughout the facility. The CNH will address employee and patient safety practices tough staff orientation, training and adherence to related policy or procedures to provide a safe and clean environment. Re-admission to the VA Hospital and Emergency Care; Notification of Death of Veterans; CNH Responsibility to Veteran s Belongings or Personal Effects (QASP Indicator #3). VA beneficiaries who begin to require more than the level of care authorized by VA will be readmitted to an appropriate VA facility, as determined and authorized by VA. The nursing home shall notify the authorizing VA facility when a medical emergency requiring re-hospitalization occurs, (within 24 hours or the first business day after a weekend or holiday). The veteran shall be readmitted to an appropriate VA facility. When such readmission is not feasible because of the nature of the emergency, hospitalization in a non-federal hospital may be accomplished provided VA authorization is obtained from the Utilization Review Nurse. VA authorization must be obtained within 72-hours of admission of the patient to a non-Federal facility and notice of any veteran death within 24-hours or immediately the first business day after a weekend or holiday. If hospitalization of a non-emergency nature is required, readmission to a VA Medical Center may be accomplished as soon as the patient s condition is sufficiently stabilized to permit admission to a VA Medical Center. In the event of a death of any veteran while receiving nursing home care under this IDC, the CNH will promptly notify the VA facility which authorized admission within 24 hours or on the first business day following a weekend or holiday and immediately assemble, inventory, and safeguard the patient s personal effects. The funds, deposits, and effects left by the VA patients upon the premises of the CNH shall be delivered by the CNH to the person(s) entitled thereto under the laws currently governing the CNH for making disposition of funds and effects left by patients, unless the beneficiary died without leaving a will, heirs or next of kin capable of inheriting. When disposition has been made, the itemized inventory with annotation as to the disposition of the funds and effects will be immediately forwarded to the VA facility authorizing admission. Should a deceased patient leave no will, heirs, or next of kin, his/her personal property and funds wherever located vests in and becomes the property of the United States in trust. In these cases, the CNH will forward an inventory of any such property and funds in its possession to the VA facility authorizing admission and will hold them (except articles of clothing necessary for proper burial) under safeguard until instructions are received from VA concerning disposition. CMS regulations require retention of records for five (5) years when there is no requirement in State law. Leave of Absence (LOA) Bed-Hold Statement. For re-hospitalizations or therapeutic passes, VA will pay a bed hold. Therapeutic passes will be authorized by the CNH staff based on individual patient needs, but are generally limited to two (2) times per month and should be pre-approved. VA will cover bed holds based on the following plan: The host VA medical center may select and approve one of the following options upon CNH request for bed hold: Up to 5 days/hospital transfer, pre-approved by VA when in the best interest of the Veteran and the VA. Exceptions approved at VAMC level: Follow Medicare: no bed holds; Follow Medicaid: rule would differ by State; When deemed appropriate, VA will reimburse the CNH applicable per diem rate for bed hold not to exceed two (2) days per episode, four (4) days total per month (see Schedule of items for applicable per diem rate); VA may reimburse according to the prevailing State Medicaid guidelines. Authorized bed-hold will begin the date the resident leaves the CNH and applicable per diem will resume on the date of readmission to the CNH. Absences of fifteen (15) consecutive calendar days or more, whether in a VA or in a non-Federal facility require a new agreement of authorization. It is the CNH s responsibility to notify the family if a bed hold is required for a longer period. The family would then make arrangements with the CNH to hold the bed. Reportable Events (QASP Indicator #4). VA requires CNHs to report to the VA CNH Coordinator or authorized VA representative any of the following events within 24-hours or the first business day after a weekend or holiday: VANCHCS Appointment Line at (800-382-8387. Reporting (see below for Reportable Events) shall include the date of occurrence, patient disposition and outcome. Sentinel events; When there is a change of ownership of the CNH; When there is a change of nursing home administrator or Director of Nursing/Director of Nursing Service; substantiated allegations of mistreatment, neglect, abuse or misappropriation of CNH veterans or property; Elopements of CNH veterans pursuant to state regulations; Infectious outbreaks; Resident to resident or resident to staff altercations involving a CNH veteran resulting in any injury that is other than minor; Copies of annual surveys or substantiated complaint investigations conducted by a State oversight agency; and Adverse events. A sentinel event may include, but is not limited to the following: A fall resulting in death or injury; Elopement resulting in a missing patient; Patient abuse confirmed or under suspicion; A medication error resulting in patient illness or injury; Death or patient injury related to restraint (including side rails) use; or Death related to an unconfirmed or suspicious cause. When an adverse event occurs involving a CNH Veteran which is not determined to be a Sentinel Event but that the State requires that the occurrence be reported), such event is also to be reported to VA s CNH Coordinator or other VA authorized representative. Some adverse events, such as minor medication errors without catastrophic outcomes, are managed by the CNH in the context of their quality improvement programs. It is not necessary for nursing homes to report such incidents to the VA CNH Coordinator. VA Actions Regarding Serious Quality of Care Deficiencies. In cases of serious deficiencies affecting the health or safety of veterans or in cases of continued uncorrected deficiencies, VA will take one or more of the following actions in accordance with the terms and clauses of the IDC and applicable procurement regulations: Increase VA staffing monitoring until the State survey agency clears the deficiency; Suspend placement of veterans in the CNH; Remove or transfer veterans under the IDC from the subject CNH; Not renew the IDC; and/or Terminate the IDC. VA Staff Access to CNH Records (QASP Indicator #5). All medical records concerning the veteran s care in the CNH will be readily accessible to VA. Upon discharge or the death of a patient, medical records will be retained by the CNH for a period of at least five (5) years following termination of care. Patient records will be maintained in conformance with the Privacy Act of 1974 (5 U.S.C. 552a). A medical record shall be maintained for each patient, which includes at least the following: VAHCS Referral Package to the CNH: Copy of Physician Orders for Nursing Home Care; CPRS Notes; Discharge Summary including History & Physical information with Medication List; Rehabilitation Progress Notes; and Veteran Demographic Record which includes next of kin information. Copy of Authorization Agreement (VAF 10-7078). Nursing Home Clinical Record: The CNH must maintain clinical records on each veteran in accordance with accepted professional standards and practice. The clinical record must be: complete, accurately documented, readily accessible, systematically organized, and legible. Clinical records must contain at a minimum: Sufficient information to identify the resident; A record of the veteran s assessments, including those assessments performed by services under the IDC with the CNH; The plan of care and services including medication administration, provided by CNH staff and services provided under the IDC with the CNH; Interdisciplinary progress notes to include effect of care provided, veterans response to treatment, change in condition, and changes in treatment; Medical practitioner orders which are signed and dated; Allergies; Person to contact in an emergency situation; Name of attending medical practitioner; and Advanced directives if available. Clinical Record Safeguards: The CNH must safeguard clinical record information (including electronic) against loss, destruction, or unauthorized use. If the CNH maintains a veteran s record by computer, electronic signatures are acceptable. If attestation is done on computer records, safeguards to prevent unauthorized access and to provide for reconstruction of information must be in place. Specialty Services. The CNH will assume responsibility for arranging specialty care for veterans (e.g., dental care, podiatry and ophthalmology). VA Health Care System Consultation/Resources. Pre-Authorizations: All pre-authorization requests can be faxed to the CNH Program Coordinator or CNH Program Assistant or Designee at 559-225-6100 Ext. 4403. Telephone Care Communications Systems (TCCS): For urgent same-day outpatient specialty care or for non-urgent scheduled clinic appointments/consultations, phone between 9 a.m. and 3 p.m. Monday tough Friday, excluding holidays. If a same-day appointment is anticipated; please call as early as possible at 559-225-6100 Ext. 6933. Admissions Conference Call Systems phone number at 559-225-6100 Ext. 3111 For non-emergency consultation or /evaluation for admission to the VA Central California Health Care System (after initial evaluation or intervention by the nursing home physician). After hours, weekends and holidays: For urgent referrals or consultation contact the Admission Conference Call System number at 559-225-6100 Ext. 3111. Transportation: Necessary transportation to and from the VA hospital for clinics, evaluation or hospitalization will be arranged and paid by the VA hospital for CNH patients when requested. For Clinic appointments, call 559-225-6100 Ext. 4031. Charitable Contributions. The CNH will not solicit contributions, donations, or gifts from patients or family members. Note: Established charitable fundraising activities of a CNH fall outside the scope of this language. CNH Billing (QASP Indicator #6). Invoices for board, care and ancillary services shall be submitted promptly to the authorizing facility by the 15th calendar day following the end of the month in which services were rendered. The CNH will promptly notify the VA CNH Coordinator or VA authorized representative regarding any change in Veteran status: discharge, transfer, against medical advice (AMA), hospitalization, death and/or any changes in payer source and any ability to complete timely billing. All prover invoices must accurately reflect the full name and address of the CNH and shall reflect the patient s name, social security number, number of days billed, authorized/approved RUG category(ies), and level of care provided/established greed upon RUG rate (s). Failure to include this information may result in delayed payment. NOTE: All invoiced services must receive prior VA authorization. Pre-approves services billed by CMS procedures or CPT codes: All VA pre-approved services, which are provided in addition to the all-inclusive per diem rate must be billed according to CMS procedures or CPT codes. The CNH will be reimbursed based on local guidelines and VA pricing schedules as authorized by the VA. High cost drugs: All requests for additional reimbursement for high cost medications not included in the all-inclusive per diem rate must be specifically requested by the CNH provider or authorized designee and must be specifically authorized by the VA. Invoices: Invoices shall be sent on the CMS-1450 (red invoice). The invoices must include the same information as provided to Medicare. Payment will be made monthly, thirty (30) days in arrears, following receipt of a properly prepared invoice. A properly prepared invoice shall include the RUG level and assessment reference date. All Services provided must be itemized (listed separately) on the invoice. Separate invoices will be submitted for each Veteran approved for services under this agreement. Any and all corrections to the invoice must be submitted for payment of any authorized ancillary costs or changes to the original invoice. All corrected invoices must include previously approved items that are affected by the correction and should be resubmitted. Minimum Quantities; VA Payment. It is impossible to determine the exact or estimated amount, which will be expended under this IDC. No obligation will be incurred by VA under this IDC, until pre-approved authorizations are issued for nursing home care of specific beneficiaries. VA agrees to make payment on a timely basis for specifically pre-approved services rendered in accordance with FAR 32.905, after receipt of proper invoices. VA will make payment for the day a recipient enters the CNH but not the day the recipient leaves a CNH unless entrance and departure are on the same day, then payment will be made for one (1) day. VA Payments. Payments made by VA under any contract pursuant to this IDC, constitute the total cost of nursing home care. No additional charges will be billed to Medicare (with the exception of hospice), Medicaid, or private insurance, the beneficiary or his/her family, either by the CNH or any third party furnishing services or supplies required for such care, unless and until specific prior authorization in writing is obtained from the VA facility authorizing placement. The patient, family and any other entitlement programs (e.g., Medicare, Medicaid, etc.) will not be billed for uncovered services or costs during the VA contract period. This constitutes double-billing and Federal fraud. Vendors who bill electronically using the HIPAA-compliant claims transactions must submit claims tough the VA clearinghouse, Emdeon, using payer ID number 12115 for medical claims. Vendors who are not able to use the HIPAA-compliant transactions are not required to do so. Supporting information for monthly invoices will be mailed to: VA Central California Health Care System Attn: Bobette Varela Social Work Service- Stop122 2615 E. Clinton Avenue Fresno, CA 93703 Records Management Language for Contracts Required: The following standard items relate to records generated in executing the contract and should be included in a typical Electronic Information Systems (EIS) procurement contract: Citations to pertinent laws, codes and regulations such as 44 U.S.C chapters 21, 29, 31 and 33; Freedom of Information Act (5 U.S.C. 552); Privacy Act (5 U.S.C. 552a); 36 CFR Part 1222 and Part 1228. Contractor shall treat all deliverables under the contract as the property of the U.S. Government for which the Government Agency shall have unlimited rights to use, dispose of, or disclose such data contained therein as it determines to be in the public interest. Contractor shall not create or maintain any records that are not specifically tied to or authorized by the contract using Government IT equipment and/or Government records. Contractor shall not retain, use, sell, or disseminate copies of any deliverable that contains information covered by the Privacy Act of 1974 or that which is generally protected by the Freedom of Information Act. Contractor shall not create or maintain any records containing any Government Agency records that are not specifically tied to or authorized by the contract. The Government Agency owns the rights to all data/records produced as part of this contract. The Government Agency owns the rights to all electronic information (electronic data, electronic information systems, electronic databases, etc.) and all supporting documentation created as part of this contract. Contractor must deliver sufficient technical documentation with all data deliverables to permit the agency to use the data. Contractor agrees to comply with Federal and Agency records management policies, including those policies associated with the safeguarding of records covered by the Privacy Act of 1974. These policies include the preservation of all records created or received regardless of format [paper, electronic, etc.] or mode of transmission [e-mail, fax, etc.] or state of completion [draft, final, etc.]. No disposition of documents will be allowed without the prior written consent of the Contracting Officer. The Agency and its contractors are responsible for preventing the alienation or unauthorized destruction of records, including all forms of mutilation. Willful and unlawful destruction, damage or alienation of Federal records is subject to the fines and penalties imposed by 18 U.S.C. 2701. Records may not be removed from the legal custody of the Agency or destroyed without regard to the provisions of the agency records schedules. Contractor is required to obtain the Contracting Officer's approval prior to engaging in any contractual relationship (sub-contractor) in support of this contract requiring the disclosure of information, documentary material and/or records generated under, or relating to, this contract. The Contractor (and any sub-contractor) is required to abide by Government and Agency guidance for protecting sensitive and proprietary information.
36C26120Q0462 Department of Veterans Affairs Veterans Health Administration Veterans Integrated Service Network 21
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