2020-0407 JOFOC 36C261-20-AP-2632 Jewish Living CNH HCA ApprovedR_Redacted.pdf

ACQ Plan #: 36C261-20-AP-2632 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-2632

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

Nature and/or Description of the Action Being Processed: VISN 21’s, San Francisco VA Medical Center (SFVAMC), has had an ongoing need of Community Nursing Home (CNH) services to replace Basic Ordering Agreement (BOA) VA261-15-G-0024 at Hebrew Home For Aged Disabled d/b/a San Francisco Campus for Jewish Living. The families of the four (4) Veteran 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 Hebrew Home For Aged Disabled d/b/a San Francisco Campus for Jewish Living, DUNS: 020004693. 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.

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 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.

Hebrew Home For Aged Disabled d/b/a San Francisco Campus for Jewish Living is currently providing a much-needed service to four (4) 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. Hebrew Home For Aged Disabled d/b/a San Francisco Campus for Jewish Living is currently a much 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 Hebrew Home For Aged Disabled d/b/a San Francisco Campus for Jewish Living.

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

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 “California” 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 79 licensed nursing homes within 25 miles from the center of 94121;

resulting in the following CNH star ratings: five (5) stars-much above average: 37, four (4) stars-above average: 23; three (3) stars-average: six (6); two (2) stars-below average: ten (10); one (1) star-much below average: three (3).

b. There is four (4) fragile, elderly, Veterans currently residing within the CNH. Relocating the Veteran 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 79 licensed nursing homes within 25 miles from the center of 94121; resulting in the following CNH star ratings: five (5) stars-much above average: 37, four (4) stars-above average: 23; three (3) stars-average: six (6); two (2) stars-below average: ten (10); one (1) star-much below average: three (3), including Hebrew Home For Aged Disabled d/b/a San Francisco Campus for Jewish Living has a five (5) star rating. A query of the Veterans Information Pages (VIP) was generated using PSC “Q402,” NAICS “623110” Key Words “Skilled Nursing Facility”, and States Searched-Strict “California” 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:

1,681,730; Male Veterans 1,538,519: Female Veterans: 143,211; Number of Military Retires: 157,276;

Veterans 65 or older: 849,750. A search on SAMBeta.gov website (Contract Opportunities only) was conducted using the following: Key Words: “Skilled Nursing Facility; Status: Active; Agency: VA