Q402--Intent to Sole Source to Ulmus Holding LLC DBA Rock Creek Care Center
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 Ulmus Holding LLC DBA Rock Creek Care Center.A A There are currently five (5) Veterans at the facility, and the current contract expires 11/01/2020.A A All responsible sources may submit a may capability statement, proposal, or quotation by August 18, 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:A A 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.A A In light of this program,A 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 toA www.sam.govA as required by Federal Acquisition Regulation (FAR) 13.01(a)(1)(iii).A Period of Performance: November 1, 2020 tough October 31, 2025 AA A A A A A A Contractors shall complete theA Price-Cost Schedule for the purpose of market research.A A AA A A A A A A Contractors shall provide sufficient data showing they have previously performed the required services identified in the Performance Work Statement (PWS).A AA A A 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 Sacramento, 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 $5,000,000.00. 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: November 1, 2020 tough October 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 Overview Federal Acquisition Regulation (FAR) Indefinite Delivery Indefinite Quantity Contract (IDIQ). In accordance with FAR 16.504, Indefinite Delivery, Indefinite Quantity Contracts, this is an IDIQ from the Award Date for a period of five years. 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 IDIQ. The VA Levels of Care are defined in an attachment in Section D.1 of the solicitation and the IDIQ. VA is obligated only to the extent authorized placement of patients is made in accordance with this IDIQ. Any adjustments or modifications to this obligation require written preauthorization. 2. Background. 1. 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 Northern California Health Care System, in Redding, California at the prices specified in the section titled Schedule of Items of this IDIQ. 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 where patient medical/psycho-social care and well-being is provided for. 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 patients. Nursing home care will be furnished to ensure the total medical, nursing, safety and psychosocial needs of VA beneficiaries. All nursing home facilities in VA s CNH program must have current Center for Medicare and Medicaid Services (CMS) certification (Medicare and/or Medicaid) and a State nursing home license. VA has developed quality of care standards utilizing CMS inspection criteria that are followed by VA CNH Program Coordinators in their initial selection and approval of nursing facilities. See VHA Handbook 1143.2, VHA Community Nursing Home Oversight Procedures (June 4, 2004) a copy of which is available at: https://www.index.va.gov/search/va/va_search.jsp?NQ=URL%3Ahttps%3A%2F%2Fwww.va.g ov%2Fvhapublications%2Fpublications.cfm&QT=CNH+Handbook&submit.x=0&submit.y=0 VA often has a particular need for specialty care services in the CNH program. The VA requires Reference: 612-21-1-2099-0001 Nursing Home Facility: Ulmus Holdings LLC (Rock Creek Care Center) CNHs to have bed capacity to ensure their ability to take referrals when requested. The CNH also must be able to accept VA referrals in a timely fashion (ideally within 24 hours of request). Provider visits will be available at the minimum rate of one (1) visit per month. Laboratory, x- ray, and other special services will be available to VA patients as needed. In addition, the care provided will include a room or private room only if clinically indicated, meals, nursing care, and other services or supplies commensurate with the VA-authorized level of care, without extra charge. Nursing Home s Responsibility for Patient Care: Duly authorized representatives of VA will provide quality oversight visits to veterans placed to assure continuity of care and to assist in the veterans transition back into the community. These visits do not substitute nor relieve the CNH in anyway of the responsibility for the daily care and medical/psycho-social treatment of the veteran. This care includes times when VA beneficiaries are transported away from the nursing home to necessary medical appointments. Adequate supervision, care and treatment supplies (i.e. portable oxygen, dressing supplies, etc.) must be provided by the nursing home when a veteran is transported away from the nursing home to a medical appointment. This applies to clinical appointments at the VA Medical Center and Clinics (CBOCs) as well as medical appointments in the local community. See section 17, e if prior authorization is clinically required to cover the cost of staff or contracted providers to accompany/escort the veteran to his VA or VA-authorized appointment. For ventilator- dependent veterans who are receiving care in sub-acute faculties a RN must always accompany them when leaving the facility for appointments; the RN must be able to maintain the veteran s airway and provide for a safe experience while away from the sub-acute facility. Private Room: Beneficiaries or their representatives may elect to pay separately for a private room. If a private room is requested, the VA beneficiary shall be obligated to pay the difference between the standard rate and the private room rate. This agreement should be in writing between the facility and the beneficiary or their legal representative, with a copy to the COR. If the contractor elects to place a VA beneficiary in a private room without a formal request, then the VA is only obligated to pay the rate for the beneficiary s current level of care under the terms of this contract. 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 or the Veteran. 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. Any extension to the original authorization validity period, regardless of the number of days, requires a new VA Form 10-7078 must be received prior to services being rendered. Medicaid/Medicare Based Rates. The current State Medicaid/Medicare rates may 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. 2 Reference: 612-21-1-2099-0001 Nursing Home Facility: Ulmus Holdings LLC (Rock Creek Care Center) 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 as soon as the veteran arrives at the CNH. The CNH provider is responsible for general medical care, urgent evaluation and intervention. 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). Provider visits: As indicated in Section C, 1 above - Primary care physician visits are required to take place at a minimum of one (1) per month. These visits are included as part of the per diem reimbursement rate, and in no case, are to be billed separately or billed to the patient or his/her family/representative. If a patient s condition requires more frequent Primary Care Physician visits or requires specialty medical evaluation and treatment (i.e., wound care M.D. specialist) prior authorization from VA is required. Additional provider visits will be reimbursed at the prevailing Medicare rate. Please refer to Appendix D for CNH Ancillary Services reimbursement protocols. Rehabilitation Criteria. All therapy provided under this IDIQ will be individual therapy, rather than group therapy, unless otherwise ordered by the authorizing VA facility. Therapy will 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. Retroactive claims will not be approved NO EXCEPTIONS. Please consult with any member of your VA CNH Team for authorization submission instructions 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. Rehab authorizations for low RUG Scores: When rehabilitative therapy frequencies do not trigger a high enough RUG score to issue the appropriate reimbursement for rehabilitative therapy, these services can be approved as an ancillary service. At the prevailing rate. Documentation should describe objective measurements which, when compared, show improvements in function, or decrease in severity, or rational for an optimistic outlook to justify continued treatment at the lower frequency. 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 3 Reference: 612-21-1-2099-0001 Nursing Home Facility: Ulmus Holdings LLC (Rock Creek Care Center) 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, nursing home staff will utilize the 911 local emergency systems as for any resident. 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 may be 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/Liability/Certifications; Access to CNH Quality of Care Reports. The CNH must maintain a current and unrestricted state license to operate as a skilled nursing facility/sub-acute facility or residential care facility. Changes in the status of the licensure will be immediately reported to the Contracting Officer Representative. The CNH must also maintain current Liability Insurance and current Center for Medicare and Medicaid Services (CMS) certifications. The VA will monitor the professional care and administrative management of services provided to VA beneficiaries under this IDIQ, 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 or quality assurance program functions relating to this IDIQ, including VA s on- site inspection and monitoring. The VA Contracting Officer and Contracting Officer s Representative shall make all final determinations as to the Contractor s reasonable cooperation with VA and compliance with these requirements. Corrective Action Plan. 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 individual; 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. The CNH must look at 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 exist and must be developed; 4 Reference: 612-21-1-2099-0001 Nursing Home Facility: Ulmus Holdings LLC (Rock Creek Care Center) 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 #101) in effect on the date of the IDIQ award and compliance with all applicable Federal, State and local regulations. The administrator of the CNH is required to notify the VA Contracting Officer 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 IDIQ became effective. The VA Contracting Officer will notify the VA Safety Manager responsible for the Life Safety Code inspection of the CNH and he/she will review (inspect the facility if required) the proposed changes and provide necessary approval or 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 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. 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. When such an admission is not feasible because of the nature of the emergency, hospitalization in a non-Federal facility may be accomplished provided VA authorization is obtained. VA 5 Reference: 612-21-1-2099-0001 Nursing Home Facility: Ulmus Holdings LLC (Rock Creek Care Center) notification must be performed within 72 hours of admission of the patient to a non-Federal facility and notice of any veteran death within 24 hours or immediately on the first business day after a weekend or holiday by faxing the approved form to the fiscally responsible VA Medical Center. 13.1.1. Upon discharge from hospitalization the CNH must submit a copy of the discharge summary to the CNH Clinical fax line (916) 640-0995. In the event of a death of any veteran, the Contractor agrees to notify VA immediately of the death. In the event a death of a VA beneficiary while receiving nursing home care under this IDIQ, the CNH will promptly notify the VA facility which authorized admission 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. Bed-Hold Statement: For re-hospitalizations or therapeutic passes, VA will pay a bed hold. The CNH is responsible for requesting all bed holds and, if applicable, bed hold renewals . VA will reimburse according to the prevailing State Medi-Cal rate or the pre-negotiated bed hold Rate. Bed old will begin the date the resident leaves the CNH and full per diem will resume on the date of readmission to the CNH. If the Veteran chooses to return to the CNH from a hospitalization under another form of coverage/insurance (Medicare/Medicaid), or if the Veteran choose not to return, or is not permitted to return to the facility the total VA bed hold reimbursement will be revoked. Absences of fifteen (15) consecutive calendar days or more, whether in a VA Hospital or in a non-VA Hospital require a new authorization agreement. Hospitalizations: If the CNH facility is requesting bed hold reimbursement the request must be submitted immediately, but no later than 48 hours after the patient left the facility. Requests submitted after 48 hours will not be approved. Hospitalization Bed Holds are approved at five (5) days maximum per episode and can be renewed up to 15-days maximum when in the best interest of the Veteran and the VA. Bed hold extensions beyond 15-days are considered on a case by case basis. The patient must present with significant clinical acuity along with limited placement options to be considered for review. Additional review by the NCHCS GEC Associate Chief of Staff. Therapeutic Leave/Home Visits: Bed holds for Therapeutic Leave/Home Visits may be authorized by the CNH Program Coordinator based on individual patient needs and safety. They are generally limited to two (2) times per month, four (4) days total per month and must be pre- approved. Retroactive requests for Therapeutic Leave/Home Visits authorizations will denied. 6 Reference: 612-21-1-2099-0001 Nursing Home Facility: Ulmus Holdings LLC (Rock Creek Care Center) Reportable Events. VA requires CNHs to report to the CNH Coordinator at VA any of the following events within 24-hours or immediately the first business day after a weekend or holiday: Sentinel events (see Section 13,a) below 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; Any time there is a substantiated complaint investigation conducted by a State oversight agency; Adverse events. Reporting shall include date of occurrence and patient disposition and outcome. 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 to the State), such event is also to be reported to VA s CNH Program Coordinator. Reporting shall include date of occurrence and patient disposition and outcome. 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 CNH Program 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 IDIQ 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 IDIQ from the subject CNH; Not renew the IDIQ; and/or Immediately terminate the IDIQ. 7 Reference: 612-21-1-2099-0001 Nursing Home Facility: Ulmus Holdings LLC (Rock Creek Care Center) VA Staff Access to CNH Records. All medical records (paper and electronic) concerning the VA Beneficiaries care in the CNH will be readily available to all authorized VA staff including clinic specialists, nurses, and social workers. VA CNH Program Nurses and Social Workers will require remote access to the CNH s electronic records. 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. A 552a). A medical record shall be maintained for each patient, which includes at least the following: 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; The plan of care medication administration record (MAR), and treatment administration record (TAR); 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 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. The VA requires that the CNH follow CMS regulations for maintaining and retaining records when there is no requirement in State law. Routine Ancillary Services are included in the per diem reimbursement rate. The CNH will assume responsibility for providing ancillary care for veterans (e.g., Dentistry, Optometry, Podiatry, etc.).and is responsible for issuing all reimbursement to sub-contracted providers with the VA SNF reimbursement funds. All Podiatry that is reasonably considered to be *basic or routine is included in the per diem reimbursement rate. At no time is the patient or the patient s family/representative to be billed for this service. The patient is expected to receive routine podiatry care every other month. All other medically necessary and non-emergent treatment of foot diseases/disorders/injuries must be received at patient s VA Medical Center. *Basic and routine Podiatry care consists of: Evaluation of the feet Cutting or removal of corns and calluses Trimming, cutting, and clipping of nails Hygienic or other preventive maintenance, including cleaning and soaking the feet 8 Reference: 612-21-1-2099-0001 Nursing Home Facility: Ulmus Holdings LLC (Rock Creek Care Center) Dentistry (basic Oral Care) and, Optometry (Vision Care), and Audiology (Hearing Care) that is reasonably considered to be *basic or routine is included in the per diem reimbursement rate. At no time is the patient or the patient s family/representative to be billed for these services. The patient is expected to receive routine care at the same frequency as a Medicare/Medi-Cal covered patient. Basic and routine Dentistry (Dental/Oral Care) includes: Oral evaluations, routine cleanings, x-rays and fluoride treatments Basic and routine Optometry (Vision Care) includes: Screening for eye disease, and/or updating eyeglass or contact lens prescriptions Basic and routine Audiology (Hearing Care) Hearing and balance assessment All other medically necessary and non-emergent treatment of diseases/disorders/injuries must be received at the patient s VA Medical Center. For patients who are unable to receive these services at their local VA Medical Center due to their significantly acute medical or cognitive status, pre-authorization is required. Documentation indicating their presenting status and their need for the additional service (a and b) must be made available for review and determination. These ancillary services include rehab at frequencies which do not trigger a RUG score. Patient may also choose to receive the above (a and b) routine and basic services at his VA Medical Center. The CNH will assist the patient with arranging necessary appointments. Routine medication review Includes routine pharmacy review and basic and routine psychotropic medication review. Clinical Record Safeguards: The CNH must safeguard clinical record information 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. CNH is required to arrange VA specialty clinic appointments when consults or treatment are needed, or in cases where patients who are medically unable to travel to a VA medical center or clinic, CNH will request pre-authorization for non-VA treatment in the local community. Travel escorts to VA appointments for patients needing assistance (due to physical, cognitive or behavioral issues) are not considered part of routine nursing home care, therefore it will be reimbursed by the VA at a reasonable and customary rate. It is the nursing home s responsibility to allocate or provide tough a third party the human resources to perform this service. The VA is not responsible for arranging or providing the staff to perform this duty. Patient travel escort reimbursements are only provided for VA authorized medical appointments, when the patient has been observed and noted to be unable to safely travel without supervision/assistance, and the 9 Reference: 612-21-1-2099-0001 Nursing Home Facility: Ulmus Holdings LLC (Rock Creek Care Center) facility has received an initial prior authorization from VA for a set duration of time. Once CNH provides documentation to VA confirming that the patient s family/legal representative has been asked and is unable to provide this assistance, a paid escort may be arranged. Escorts do not require prior authorization for each individual appointment as long as the initial authorization has been granted and escort services are provided prior to the end date of the approval. Payment will be limited to the days that veteran had VA appointments, and will be reimbursed at usual and customary rates, not to exceed $32 per hour. An itemized bill must be submitted with claims in order to receive reimbursement. 21.1.1. Patients who are receiving inpatient psychiatric care in a Contracted Secured Inpatient Psychiatric/Behavioral Healthcare Facility (IMD/ICF-MI) Travel escorts are pre-approved upon the patient s admission. 1:1 patient supervision is not considered part of routine nursing home care. This service must be pre-authorized. It is the nursing home s responsibility to allocate the human resource to perform this service. The VA is not responsible for arranging or providing the staff to perform this duty. Pre-authorization for 1:1 patient supervision reimbursement is only provided when the patient presents as an increased safety concern due to increased medical/cognitive/psychiatric acuity. The nursing home is responsible for submitting the request for 1:1 supervision in writing along with clinical justification/documentation indicating the patient s presenting symptomology. The request must include the hours being requested and note the frequency and length of time the service will be required (i.e., during waking hours only, 12/24 hours for 3 weeks) along with a plan of care to manage the presenting symptoms. An itemized bill must be submitted with claims in order to receive reimbursement. Respite Care: The purpose of this level of care is to provide temporary relief to the primary care giver to help the veteran to continue reside in their primary residence for as long as possible. It is designed to accommodate referrals with minimum care needs. Patients with more complex care needs may not be appropriate for this level of care. Inpatient CNH respite reimbursement is provided at the VA s discretion and must be pre-approved by a VA authorized official. Respite coverage is limited to 30 days per fiscal year. No extensions will be granted at any time. No exceptions to this clause and the restrictions noted below will be granted. No rehabilitation services , skilled services, 1:1 sitter or escort services, transportation services or ancillary services of any kind will be reimbursed during an episode of respite coverage . The cost of medications during respite stays will not be reimbursed . Patient medication issuance or costs must be managed between the patient and the nursing home prior to the patient s respite admission. Inpatient respite discharge plans including discharge transportation must be pre-arranged between the patient/patient s legal representative and the nursing home. The VA will not be responsible for uninsured respite stays beyond the 30-calendar days. CNH Hospice Coverage: Reimbursement for inpatient CNH hospice care requires pre- authorization. Approval will only be considered for established VA patients who meet hospice 10 Reference: 612-21-1-2099-0001 Nursing Home Facility: Ulmus Holdings LLC (Rock Creek Care Center) clinical criteria, are enrolled in hospice services, and in conjunction with VA provider review and concurrence. This level of coverage is limited to a 6-month period of time after which additional VA Provider review and re-certification will be required for additional coverage approval. It is the responsibility of the CNH facility to request coverage extensions beyond the initial 6-months. It is also the responsibility of the CNH facility to notify the designated VA official of any patient hospice care disenrollment. A grace period of up to 30-days maximum will be provided for patients who no longer desire hospice care or meet hospice criteria to aid in their transition home or to apply for additional/alternative coverage. Rehabilitation therapy or other ancillary services for restorative purposes will not be approved while patient is under hospice coverage. VA Health Care System Consultation/Resources. Pre-Authorizations: All pre-authorization requests should be faxed to 916-640-0995, the CNH Program Office. Telephone Care Communications Systems (TCCS): For urgent, same-day, outpatient, specialty care or for non-urgent scheduled clinic appointments/consultations, phone (800) 382-8387. between 7 a.m. and 7 p.m. Monday tough Friday, excluding holidays. If a same-day appointment is anticipated; please call as early as possible. After hours, weekends and holidays: Registered nurses are available to provide enrolled veterans with free, confidential health questions 24 hours a day, 7 days a week tough our toll-free telephone care program, at (800) 382-8387. Transportation: Medically necessary transportation to and from VA medical appointments will be authorized by the paying VA Healthcare System. Travel can only be arranged for authorized CNH patients and only when requested by the CNH facility with at least 48 business hours advanced notice. For initial transportation requests, contact the CNH Program Coordinator/Social Worker. 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. Invoices for IDIQ 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. Items not pre-authorized will not be processed. The CNH will promptly notify the VA CNH Program Coordinator regarding any change in Veteran status: discharge, transfer, against medical advice (AMA), hospitalization, death (use form titled Nursing Home Notification of Discharge or Death and fax to CNH Program) and/or any changes in payer source and any inability to complete timely billing. All invoices must include the full name and address of the CNH and shall reflect the 11 Reference: 612-21-1-2099-0001 Nursing Home Facility: Ulmus Holdings LLC (Rock Creek Care Center) patient s name, social security number, number of days billed, and agreed upon rate (s). Failure to include this information may result in delayed payment. The current CNH Billing Cover Sheet can be obtained from the VA Fee Basis/Purchased Care Department. 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: If reimbursement rates are based off Medicare RUG rates, all medications are included in the per diem rate, with the exception of high cost medication including but not limited to HIV and Hep C medications. If reimbursement rates are based off Medi-Cal rates then medications, which comprise more than 8.5% of the monthly per diem rate are excluded from the rate(s) established here. The cost of any high-priced drugs will be determined or priced using the Average Wholesale Price (AWP) of the drugs, plus a transaction fee of 3% per month. All calculations will be made monthly. When a high cost drug patient is identified, VA staff must be advised promptly to establish an appropriate course of action, which may include the provision of the medication by the VA. It is recommended that the accepting CNH request sufficient quantities of medication from the institution that the patient is being transferred from for the convenience and the ease of transition of the patient. Invoice Correction: Corrected invoices must be submitted for additional payment of any VA pre- authorized ancillary costs or changes to the original billing. Items not pre-authorized will not be processed. All corrected invoices must include all items that are affected by the change and should include the CNH corrected claim form (available from VA Fee Basis/Purchased Care. Minimum Quantities; VA Payment. It is impossible to determine the exact or estimated amount, which will be expended under this IDIQ. No obligation will be incurred by VA under this IDIQ, until authorizations are issued for nursing home care of specific beneficiaries. VA agrees to make payment on a timely basis for services rendered in accordance with such authorizations upon receipt of proper invoices submitted by the CNH as outlined in this IDIQ. 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 IDIQ, 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 services or costs reimbursed by the VA during the VA covered/contracted period. This constitutes double-billing and Federal fraud. Due Process. If, in the planning process for a community placement, it is discovered that the patient or patient representative objects to outplacement, they should be made aware that they may present clinical information relating to the patient s condition which would prevail against the discharge plan. The patient, or patient representative will be given up to 1-week from receipt of the discharge notice to indicate their intent to present such information. 12 Reference: 612-21-1-2099-0001 Nursing Home Facility: Ulmus Holdings LLC (Rock Creek Care Center) The subsequent length of time allowed for the family to present the evidence should be reasonable and based on the nature and source of information to be provided up a maximum of 7- calendar days. The clinical information presented must be reviewed by the CNH attending physician who will decide whether or not to continue with discharge planning. A decision to proceed with discharge planning will be reviewed by the VA Medical Center Geriatrics, Palliative and Extended Care Leadership for concurrence. The patient or patient s representative will be notified in writing of the decision. The normal steps for either discharge planning or for continued CNH care will be followed. The case may be reviewed at any time there is new medical evidence that the veteran has reached the maximum benefit of CNH care. 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 or faxed to: For patients authorized by the VA Palo Alto Health Care System, the Government Invoice Address is: VA Palo Alto Health Care System 795 Willow Road, 640/136C Attn: Joellen Perkins Menlo Park, CA 94025 For patients authorized by the VA Central California Health Care System, the Government Invoice Address is: Department of Veterans Affairs VA Central California Health Care System Attn: Bobette Varela Email: Bobette.Varela@va.gov 2615 E. Clinton Avenue Fresno, CA 93703 For patients authorized by the VA Northern California Health Care System, the Government Invoice Address is: Department of Veterans Affairs Attn: Non-VA Care/Fee Service (612-04F) 201 Walnut Avenue Mare Island, CA 94592 For patients authorized by the VA Pacific Islands Health Care System, the Government Invoice Address is: 13 Reference: 612-21-1-2099-0001 Nursing Home Facility: Ulmus Holdings LLC (Rock Creek Care Center) Department of Veterans Affairs Attn: GREC Center for Aging 459 Patterson Road Honolulu, HI 96819 27.3.5. For patients authorized by the VA San Francisco Health Care System, the Government Invoice Address is: San Francisco VA Medical Center Attn: Evangeline Van Taylor (181/G) 4150 Clement Street San Francisco, CA 94121 and for pre-authorized ancillary charges not covered by the contract, the SFVAMC Government Invoice Address is: Non-VA Care SFVAMC 901 Market Street Suite 390E San Francisco, CA 94103 27.3.6. For patients authorized by the VA Sierra Nevada Health Care System, the Government Invoice Address is: VA Sierra Nevada Health Care System Attn: Dixie Langus 975 Kirman Avenue Reno NV 89502 27.3.7. For patients authorized by the VA Southern Nevada Health Care System, the Government Invoice Address is: VA Southern Nevada Health Care System Attn: Cheryl Martin 6900 N Pecos Road Las Vegas NV 89086 14 Reference: 612-21-1-2099-0001 Nursing Home Facility: Ulmus Holdings LLC (Rock Creek Care Center) 15 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 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 prior written consent of 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 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. END PERFORMANCE WORK STATEMENT
36C26121Q0014 Department of Veterans Affairs Veterans Health Administration Veterans Integrated Service Network 21
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