2020-0393 JOFOC 36C261-20-AP-1877 CNH Ann Pearl HCA APPROVED_Redacted.pdf

ACQ Plan #: 36C261-20-AP-1877 Page 1 of 5

DEPARTMENT OF VETERANS AFFAIRS

Justification and Approval (J&A) For

Other Than Full and Open Competition (>SAT)

Acquisition Plan Action ID: 36C261-20-AP-1877

1. Contracting Activity: Department of Veterans Affairs, Regional Procurement Office (RPO) West, Network Contracting Office 21 (NCO 21)

2. Nature and/or Description of the Action Being Processed: VISN 21’s, VA Pacific Islands Health

Care System (VAPIHCS), has had an ongoing need of Community Nursing Home (CNH) services to replace Basic Ordering Agreement (BOA) VA261-15-G-0044 at Ann Pearl Care Home, Inc. d/b/a Ann Pearl Nursing Facility. The families of the five (5) Veterans who are currently located at the facility do not want to move their family members due to medical hardship on the patients, disruption in treatment plan, and disruption to family members in the local area.

In accordance with (IAW) FAR 6.302-1, Only One Responsible Source and No Other Supplies or Services Will Satisfy Agency Requirements, a sole source award will be made to Ann Pearl Care Home, Inc. d/b/a Ann Pearl Nursing Facility, DUNS: 0662755140. The type of contract will be a Fixed Price (FP) Indefinite Delivery Indefinite Quantity (IDIQ) with an Economic Price Adjustment (EPA) consisting of five (5) one (1)-year ordering periods.

FAR 13.5 Simplified Procedures for Certain Commercial Items: This procurement will be accomplished IAW FAR 13.5 Simplified Procedures for Certain Commercial Items and specifically FAR 13.501 Special Documentation Requirements, where acquisitions conducted under Simplified Acquisition Procedures are exempt from the requirements of FAR Part 6, but still require a justification using the format of FAR 6.303-2.

3. Description of Supplies/Services Required to Meet the Agency’s Needs: The proposed action is to award a FP IDIQ with EPA with the rates adjusting only to the current published Medicaid rate, with a nursing home facility capable of furnishing the total medical, nursing, and psychosocial needs of VA beneficiaries.

All nursing homes facility(s) must have current Center of Medicare and Medicaid Services

(CMS) certification (Medicare and/or Medicaid) and a State nursing home license.

The VA requires 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 must be provided at the 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 room, meals, nursing care, and other services or supplies commensurate with the VA-authorized level of care, without extra charge.

The per diem rate(s) established in this IDIQ will include the cost of primary medical care, one

(1) provider visit per month and needed consultation, drugs and routine supplies, laboratory, x-ray, and other special services authorized by VA, unless otherwise specifically excepted.

Full attention shall be given to motivating and educating patients to achieve and maintain independence in the activities of daily living. Every effort shall be made to keep patients ambulatory and to achieve an optimal level of self-care.

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The total estimated value of the proposed action is not to exceed (NTE) over the term of the IDIQ for five (5) one-year ordering periods and will allow for increased needs over the government’s estimate.

Total Estimated Annual Cost for facility:

Total Estimated 5-Year Cost for facility:

IDIQ Limit:

4. Statutory Authority Permitting Other than Full and Open Competition: FAR 13.5 Simplified Procedures for Certain Commercial Items; the authority for applying the Simplified Procedures for Commercial Items of FAR 13.5 is 41 USC §1901 and is as implemented by for restricting competition on this procurement via FAR 13.106-1(b)(2).

(1) Only One Responsible Source and No Other Supplies or Services Will Satisfy Agency Requirements per FAR 6.302-1;

(2) Unusual and Compelling Urgency per FAR 6.302-2;

(3) Industrial Mobilization, Engineering, Developmental or Research Capability or Expert

Services per FAR 6.302-3;

(4) International Agreement per FAR 6.302-4

(5) Authorized or Required by Statute FAR 6.302-5;

(6) National Security per FAR 6.302-6;

(7) Public Interest per FAR 6.302-7;

5. Demonstration that the Contractor’s Unique Qualifications or Nature of the Acquisition

Requires the Use of the Authority Cited Above (applicability of authority):

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.

The quality of care for the Veteran is accomplished through placement in a nursing home that is in close proximity to where the Veteran and his/her family resides. Notably, in the VA’s community nursing home program, the Veteran’s placement decision is made by the VA clinician(s)/provider(s), the Veteran, and the Veteran’s family. The placement decision will be based on established VA contracts within the catchment area the Veteran resides. The geographic factor in these circumstances makes this requirement unique and, therefore, not subject to competition.

Ann Pearl Care Home, Inc. d/b/a Ann Pearl is currently providing a much-needed service to five (5) Veterans within the immediate geographical location of the facility. The nursing home meets VA exclusion review quality of care standards. The nursing home currently holds a five (5) star overall rating on Medicare.gov | Nursing Home Compare. Ann Pearl Care Home, Inc. d/b/a Ann Pearl Nursing Facility is currently an above average facility that will lessen the burden and concerns of the Veteran, the Veteran’s family, and the VA clinician(s)/provider(s), by continuing a much-needed unique service, in a particular locale, that is currently covered by an active BOA. The Veterans qualify to be a beneficiary of CNH services through the VA CNH program. It would cause medical hardship on the Veterans to move them. The move may disrupt treatment plans and may become a burden to family members if the Veterans are relocated to a different facility. To avoid disruption to the Veterans, the VA must award a new contract to Ann Pearl Care Home, Inc. d/b/a Ann Pearl Nursing Facility.

6. Description of Efforts Made to ensure that offers are solicited from as many potential sources as deemed practicable:

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a. A query of the Veterans Information Pages (VIP) was generated using PSC “Q402,” NAICS “623110” Key Words “Skilled Nursing Facility”, and States Searched-Strict “Hawaii” which produced zero (0) Service-Disabled Veteran Owned Small Businesses (SDVOSBs) or Veteran Owned Small Businesses (VOSBs). A query on Medicare.gov | Nursing Home Compare confirmed there are a total of 44 licensed nursing homes within the State of Hawaii; resulting in the following CNH star ratings: five (5) stars-much above average: 22, four (4) stars-above average: ten (10); three (3) stars-average: two (2); two (2) stars-below average: seven (7); one

(1) star-much below average: one (1).

b. There are five (5) fragile, elderly, Veterans currently residing within the CNH. Relocating the Veterans to another facility already under contract would have a negative impact on the patient care and necessitates sole sourcing this procurement.

c. In accordance with FAR 13.501(a)(1)(iii), this action will be synopsized at award on Contracting Opportunities and the justification will be made publicly available.

7. Determination by the CO that the Anticipated Cost to the Government will be Fair and Reasonable:

Fair and reasonable pricing will be determined IAW FAR 13.106-3(a)(2). Pricing will be evaluated to be fair and reasonable based on a comparison to the Independent Government Cost Estimate (IGCE), and established Medicare Resource Utilization Group (RUG IV) rates and or the state issued Medicaid rate. In addition, upon receipt of the Contractor’s quote, the Contracting Officer will request/negotiate a discount of the original rates/percentages received; ensuring the rates are fair and reasonable. The Government estimate was prepared based on established Medicaid RUG IV rates for various levels of care and established VA nursing home rates based on VA national guidelines for determining cost for VA nursing home contracts.

8. Description of the Market Research Conducted and the Results, or a Statement of the Reasons Market Research Was Not Conducted:

CNH services are considered to be a commercial service, therefore market research was conducted using the following platforms: Medicare.gov | Nursing Home Compare, Veteran Information Pages (VIP), VA website for Veteran population data, SAMBeta.gov website (Contract Opportunities only), SBA’s Dynamic Small Business Search Tool, North American Industry Classification System (NAICS), and GSA’s Schedules Library. The last method of market research conducted for this unique service, is the on-going periodic outreach with local potential Contractors, conducted by the CNH Coordinator and Contracting Officer’s Representative (COR). The search using Medicare.gov | Nursing Home Compare, conducted by the CS, confirmed there are a total of 44 licensed nursing homes within the State of Hawaii; resulting in the following CNH star ratings: five (5) stars-much above average: 22, four (4) stars-above average: ten (10); three (3) stars-average: two (2); two (2) stars-below average: seven (7); one (1) star-much below average: one (1), including Ann Pearl Care Home, Inc.

d/b/a Ann Pearl Nursing Facility. A query of the Veterans Information Pages (VIP) was generated using PSC “Q402,” NAICS “623110” Key Words “Skilled Nursing Facility”, and States Searched- Strict “Hawaii” which produced zero (0) Service-Disabled Veteran Owned Small Businesses (SDVOSBs) or Veteran Owned Small Businesses (VOSBs).

The VA website for Veteran population data provided the following FY 2017 Veteran Population:

112,304; Male Veterans 100,398: Female Veterans: 11,906; Number of Military Retires: 17,935;

Veterans 65 or older: 50,134. A search on SAMBeta.gov website (Contract Opportunities only) was conducted using the following: Key Words: “Skilled Nursing Facility; Status: Active; Agency: VA resulting in (0) opportunities. SBA’s Dynamic Small Business Search Tool was used with the following search criteria: NAICS “623110” Key Words “Skilled Nursing Facility”, and States Searched-Strict “Hawaii” “SDVOSB” and “VOSB” which produced zero (0) SDVOSB or VOSB. A query on NAICS using the following search criteria: Key Words “Skilled Nursing Facility” resulted in the following

ACQ Plan #: 36C261-20-AP-1877 Page 4 of 5 code: 623110. A search on GSA library using the following: Key Words “Community Nursing Home Service” “Skilled Nursing Facility” resulted in, no matches found using your search criteria.

9. Any Other Facts Supporting the Use of Other than Full and Open Competition:

As prescribed in VHA Handbook 1143.2, the CNH Program has maintained two (2) corner stones:

some level of patient/Veteran choice in choosing a nursing home close to the Veteran’s home and family; and a unique approach to local oversight of CNHs. Thus, the Veteran, the Veteran’s family and CNH program personnel will have the choice of selecting a nursing home best suitable for the Veteran’s need. The geographic factor in the CNH service makes the requirement unique and, therefore, not subject to competition. The Veteran’s, and family member(s) location, prior to the authorization for the unique service is the driving force behind the geographical location of the CNH. The VA does not intend on disrupting the Veteran’s quality of life, by separating the patient from his/her family member(s) due to the required unique service; in saying that, it is in the best interest of the Veteran(s) and Government to award a sole source FP IDIQ with EPA to Ann Pearl Care Home, Inc. d/b/a Ann Pearl Nursing Facility to support VAPIHCS’s mission, the Veteran(s).

10. Listing of Sources that Expressed, in Writing, an Interest in the Acquisition:

The Contractor, Ann Pearl Care Home, Inc. d/b/a Ann Pearl Nursing Facility is currently providing CNH services to five (5) Veterans. The Contractor is willing to continue providing services to the Veterans receiving services in the facility.

11. A Statement of the Actions, if any, the Agency May Take to Remove or Overcome any Barriers to Competition before Making subsequent acquisitions for the supplies or services required:

Based on the inherent nature of the service and in line with VA policy where the Veteran and his/her family play a role in determining which nursing home facility will provide treatment for the Veteran, the opportunity to increase competition is limited. Notwithstanding the foregoing limitations, the Government intends to post a reoccurring Open and Continuous (O&C) Solicitation in fiscal year 2021 to increase the number of quality CNH providers, so when new beneficiaries require the unique service, they will have more available choices, outside of the currently contracted facilities, thereby increasing competition. The O&C will further publicize the VA’s need for CNHs throughout VISN 21’s catchment area, whereby proposals are received on a rolling basis for up to one (1) year. The source selections would occur periodically throughout the life of the O&C, based on the needs of the Veteran(s), within the VISN’s catchment area. Through these efforts, NCO 21 anticipates a significant increase in quality contracted nursing homes for VISN 21’s mission, and a sudden decrease in sole source requirements, given the market will be engaged from a competitive platform once the reoccurring O&C is posted for 365 calendar-days.

12. Requirements Certification: I certify that the requirement outlined in this justification is a Bona Fide Need of the Department of Veterans Affairs and that the supporting data under my cognizance, which are included in the justification, are accurate and complete to the best of my knowledge and belief.

Terry Leong Date Program Manager

13. Approvals in accordance with the VHAPM Part 806.3 OFOC SOP:

TERRY S.

LEONG 298733

Digitally signed by

TERRY S. LEONG 298733

Date: 2020.09.16 09:05:09 -10'00'

ACQ Plan #: 36C261-20-AP-1877 Page 5 of 5

a. Contracting Officer or Designee’s Certification (required): I certify that the foregoing justification is accurate and complete to the best of my knowledge and belief.

Gary T. Basile Date Contracting Officer Network Contracting Office (NCO) 21

b. One Level Above the Contracting Officer (Required over SAT but not exceeding $700K): I certify the justification meets requirements for other than full and open competition.

Brooke C. Robison Date Director of Contracting Network Contracting Office (NCO) 21

c. VHA RPO HCA Review and Approval: I have reviewed the foregoing justification and find it to be complete and accurate to the best of my knowledge and belief and recommend approval (if over $13.5 million) or approve ($700K to 13.5 million) for other than full and open competition.

Curtis M. Jordan Date Executive Director, Regional Procurement Office West Head of Contracting Activity (HCA)

17 SEP 20

Gary T Basile 228349 Digitally signed by Gary T Basile 228349 Date: 2020.09.17 06:55:01 -07'00'

Brooke C. Robison 1615983

Digitally signed by Brooke C.

Robison 1615983 Date: 2020.09.17 11:17:05 -07'00'

Jordan, Curtis M.

(RPO)

Digitally signed by Jordan, Curtis

M. (RPO)

Date: 2020.09.18 12:23:02 -06'00'