36C24220R0001.docx

36C24220R0001

PAGE 1 OF

1. REQUISITION NO.

2. CONTRACT NO.

3. AWARD/EFFECTIVE DATE

4. ORDER NO.

5. SOLICITATION NUMBER

6. SOLICITATION ISSUE DATE

a. NAME

b. TELEPHONE NO. (No Collect Calls)

8. OFFER DUE DATE/LOCAL

TIME

9. ISSUED BY

CODE

10. THIS ACQUISITION IS

UNRESTRICTED OR

SET ASIDE:

% FOR:

SMALL BUSINESS

HUBZONE SMALL

BUSINESS

SERVICE-DISABLED

VETERAN-OWNED

SMALL BUSINESS

WOMEN-OWNED SMALL BUSINESS

(WOSB) ELIGIBLE UNDER THE WOMEN-OWNED

SMALL BUSINESS PROGRAM

EDWOSB

8(A)

NAICS:

SIZE STANDARD:

11. DELIVERY FOR FOB DESTINA-

TION UNLESS BLOCK IS

MARKED

SEE SCHEDULE

12. DISCOUNT TERMS

13a. THIS CONTRACT IS A

RATED ORDER UNDER

DPAS (15 CFR 700)

13b. RATING

14. METHOD OF SOLICITATION

RFQ

IFB

RFP

15. DELIVER TO

CODE

16. ADMINISTERED BY

CODE

17a. CONTRACTOR/OFFEROR

CODE

FACILITY CODE

18a. PAYMENT WILL BE MADE BY

CODE

TELEPHONE NO.

DUNS:

DUNS+4:

PHONE:

FAX:

17b. CHECK IF REMITTANCE IS DIFFERENT AND PUT SUCH ADDRESS IN OFFER 18b. SUBMIT INVOICES TO ADDRESS SHOWN IN BLOCK 18a UNLESS BLOCK BELOW IS CHECKED

SEE ADDENDUM

19.

20.

21.

22.

23.

24.

ITEM NO.

SCHEDULE OF SUPPLIES/SERVICES

QUANTITY

UNIT

UNIT PRICE

AMOUNT

(Use Reverse and/or Attach Additional Sheets as Necessary)

25. ACCOUNTING AND APPROPRIATION DATA

26. TOTAL AWARD AMOUNT (For Govt. Use Only) 27a. SOLICITATION INCORPORATES BY REFERENCE FAR 52.212-1, 52.212-4. FAR 52.212-3 AND 52.212-5 ARE ATTACHED. ADDENDA

ARE

ARE NOT ATTACHED.

27b. CONTRACT/PURCHASE ORDER INCORPORATES BY REFERENCE FAR 52.212-4. FAR 52.212-5 IS ATTACHED. ADDENDA

ARE

ARE NOT ATTACHED

28. CONTRACTOR IS REQUIRED TO SIGN THIS DOCUMENT AND RETURN _______________

29. AWARD OF CONTRACT: REF. ___________________________________ OFFER

COPIES TO ISSUING OFFICE. CONTRACTOR AGREES TO FURNISH AND

DATED ________________________________. YOUR OFFER ON SOLICITATION

DELIVER ALL ITEMS SET FORTH OR OTHERWISE IDENTIFIED ABOVE AND ON ANY

(BLOCK 5), INCLUDING ANY ADDITIONS OR CHANGES WHICH ARE

ADDITIONAL SHEETS SUBJECT TO THE TERMS AND CONDITIONS SPECIFIED

SET FORTH HEREIN IS ACCEPTED AS TO ITEMS:

30a. SIGNATURE OF OFFEROR/CONTRACTOR 31a. UNITED STATES OF AMERICA (SIGNATURE OF CONTRACTING OFFICER) 30b. NAME AND TITLE OF SIGNER (TYPE OR PRINT) 30c. DATE SIGNED 31b. NAME OF CONTRACTING OFFICER (TYPE OR PRINT) 31c. DATE SIGNED

AUTHORIZED FOR LOCAL REPRODUCTION

(REV. 2/2012)

PREVIOUS EDITION IS NOT USABLE

Prescribed by GSA - FAR (48 CFR) 53.212

7. FOR SOLICITATION

INFORMATION CALL:

STANDARD FORM 1449

OFFEROR TO COMPLETE BLOCKS 12, 17, 23, 24, & 30

SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL ITEMS

36C24220R0001 08-22-2020

CHERYL WHITTON

518-626-5456 09-30-2021

3PM

Department of Veterans Affairs Network Contracting Activity 20 Madison Avenue Extension Albany

NY

12203 X 623110 $27.5 Million N/A X VA Medical Center Making Referral

Department of Veterans Affairs Network Contracting Office (NCO2) 20 Madison Avenue Extension Albany

NY

12203

The Medical Center making the referral

As a result of this Request for Proposals (RFP), the Government anticipates awarding multiple Indefinite Delivery Contracts (IDC) under authority 38 U.S. C. 1720 for Nursing Home Services for eligible veterans of the Department of Veterans Affairs in the following New York State Counties:

Albany (3); Allegany (1); Bronx (5); Broome (1); Cayuga (1);

Cattaraugus (3); Chemung (1); Columbia (1); Erie (13);

Franklin (1); Jefferson (1); Lewis (1); Livingston (1);

Madison (1); Monroe (3); Nassau (4); Oneida (2);

Onondaga (2); St. Lawrence (1); Steuben (1); Suffolk (4);

Tompkins (1); Wayne (1); Yates (1) X X Allan Preston Contracting Officer Table of Contents

SECTION B - CONTINUATION OF SF 1449 BLOCKS

B.1 CONTRACT ADMINSTRATION DATA (Continuation of SF 1449 Blocks 5-18)

All contract administration matters will be handled by the following individual(s):

a. Contractor _________________________________________________

Address ___________________________________________________

City/State/Zip ______________________________________________

Facility Name ______________________________________________

County ___________________________________________________

Point of Contact (name and position) ____________________________

Telephone Number __________________________________________

Fax Number _______________________________________________

Email Address _____________________________________________

NPI Number ______________________________________________

TAX ID Number ____________________________________________

DUNS NUMBER _____________________________________________

b. Government:

Contracting Officer Allan Preston, Branch Chief Department of Veterans Affairs, Network Contracting Office 2 2875 Union Road, Suite 3500 Cheektowaga, NY 14227

Solicitation Cheryl Whitton, Contract Specialist Department of Veterans Affairs, Network Contracting Office 2 20 Madison Avenue Extension Albany, NY 12203 Phone: 518-626-5456 Email: Cheryl.Whitton@va.gov

Onondaga, St Lawrence, Albany Counties (Albany, Syracuse, Canandaigua, Bath areas) Danelle Wassink, Contract Specialist Department of Veterans Affairs, Network Contracting Office 2 76 Veterans Avenue Bath, NY 14810 Phone: 607-664-4783 Email: Danelle.Wassink@va.gov

Suffolk, Nassau, Orange Counties (Hudson Valley, Bronx and New Jersey areas) Regina Ricciardi, Contract Specialist Department of Veterans Affairs, Network Contracting Office 2 2094 Albany Post Road, Rt. 9A, Bldg. 4 Room 12 Montrose, NY 10548 Phone: 914-737-4400 ext. 3198 Email: Regina.Ricciardi@va.gov

Erie & Niagara County (Buffalo area) Cheryl Whitton, Contract Specialist Department of Veterans Affairs, Network Contracting Office 2 20 Madison Avenue Extension Albany, NY 12203 Phone: 518-626-5456 Phone: 518-626-5456 Email: Cheryl.Whitton@va.gov

2. GOVERNMENT INVOICE ADDRESS: Address invoices as instructed by the VA Medical Center making placement.

3. INVOICES: Invoices shall be submitted in arrears:

4. CONTRACT MODIFICATIONS: The Contractor is advised that only the Contracting Officer, acting within the scope of the contract and his/her duties and responsibilities and after advice and consultation with the Contracting Officer’s Representative (COR), has the authority to make changes that will affect contract prices, quantity, quality, delivery terms and conditions, or the term of the contract. In no event shall any understanding or agreement, modification, change order, or other matters in deviation from the terms of this contract between Contractor and a person other than the Contracting Officer be effective or binding upon the Government. All such actions must be formalized by the proper contractual document executed by the Contracting Officer.

5. SYSTEM FOR AWARD MANAGEMENT (SAM): Per FAR 4.1102, all offerors must be listed in SAM at the time of offers due AND at the time of award. SAM includes the functionality of the previous Central Contractor Registration (CCR) and Online Representations and Certifications Applications (ORCA). No contract will be entered into with an unregistered contractor. Internet access allows registration by completing an electronic online registration application at http://www.beta.sam.gov/.

6. CONTRACTING OFFICER’S REPRESENTATIVE: Prior to award, the Contracting Officer will designate the Program Specialist for Primary Care to act as Contracting Officer’s Representative (COR). All work coordination shall be made through the COR. The Contractor shall be provided a copy of the letter of delegation authorizing the COR at the commencement of the term of this agreement. No other person shall be authorized to act in such capacity unless appointed in writing by the Contracting Officer.

7. SOLICITATION/CONTRACT: This solicitation and resulting contract adheres to the format defined in Federal Acquisition Regulation (FAR) Parts 12 and 15. An official copy of the FAR can be obtained at https://www.acquisition.gov/far/ .

8. POST AWARD ORIENTATION (Awards over $1M): The Contracting Officer will schedule a post award orientation conference for contract orientation purposes as required by IL 003A3-12-04, which is available at http://www.va.gov/oal/docs/library/ils/il12-04.pdf.

9. SECURITY LANGUAGE: The contractor retained to do work for VA under this contract requires the use and transmission of VA Sensitive Personal Information (SPI) and must follow and adhere to the security controls, enhancements, compensating controls, protocols, regulations, and VA directions as the Contracting Officer (CO) shall direct, including, but not limited to those derived from the Federal Information Security Management Act (FISMA), OMB Circular No. A-130 and VA Handbook 6500/6500.6. The contractor must report any data breach according to the protocols and timeframes in HB 6500.

If the contractor retained to do work for VA under this contract requires access, use, etc., of VA SPI as aforesaid, and if an actionable data breach occurs because of the contractor’s acts, omissions, or negligence in following the VA-directed security controls, enhancements, compensating controls, protocols, and/or measures, including, but not limited to the sources above, the contractor is further subject to the statutory requirement to assess liquidated damages under 38 U.S.C. §5725 in the event of a breach of Sensitive Personal Information (SPI)/ Personally Identifiable Information (PII). Said liquidated damages shall be assessed at $37.50 per affected Veteran or beneficiary. A breach in this context includes the unauthorized acquisition, access, use, or disclosure of VA SPI which compromises not only the information’s security or privacy but that of the Veteran or beneficiary as well as the potential exposure or wrongful disclosure of such information as a result of a failure to follow proper data security controls and protocols.

a. VA Handbook 6500 requires the following statement on fax sheets be included:

This fax is intended only for the use of the person or office to which it is addressed and may contain information that is privileged, confidential, or protected by law. All others are hereby notified that the receipt of this fax does not waive any applicable privilege or exemption for disclosure and that any dissemination, distribution, or copying of this communication is prohibited. If you have received this fax in error, please notify this office immediately at the telephone number listed above.

b. If facsimile transmission is used to transmit orders or other necessary patient information to the Contractor, the fax location shall be secure and only accessible by those individuals who will be involved in the care of or administration of the referred veteran.

c. The VA may use the United States Post Office to send the start orders or other information as required.

d. The Contractor shall submit invoices or any document containing personally identifiable information via the United States Post Office or fax transmission to the program office as instructed by the Contracting Officers Representative.

e. E-mailing any personally identifiable patient information or protected health information is strictly prohibited.

10. TECHNICAL INQUIRIES: Direct all technical inquiries in writing to Contract Specialist, Cheryl Whitton via email at: Cheryl.Whitton@va.gov. ALL inquiries must be in writing.

11. PROPOSAL DELIVERY: Offers shall be submitted electronically to Cheryl Whitton at: Cheryl.Whitton@va.gov. Proposals shall be submitted following the format outlined in Section E.1 – Addendum to 52.212-1 Instructions to Offerors – Commercial Items (page 62). Any offers received via fax or mailed will not be accepted and those offers will be deemed technically unacceptable and will not be evaluated. Furthermore, offers via FedEx, UPS, thumb or Pin drives, etc. fall within the category of "mailed" offers and such offers will also summarily be rejected.

12. ACKNOWLEDGMENT OF AMENDMENTS: The offeror acknowledges receipt of amendments to the Solicitation numbered and dated as follows:

B.2 SCHEDULE OF ITEMS

1. Rate Determination: The VA is seeking preferred rates, based on patient care need. VA rates are an all-inclusive per diem rate. The per diem rate(s) will apply throughout the term of this Indefinite Delivery Contract (IDC). While the VA uses State Medicaid rates as a reference, VA rates are independent of those payment systems and governed by the terms of this IDC. The per diem rate utilizes the Resident Assessment Instructions (RAI)/Minimum Data Set (MDS) assessment and RUGS score as the reference for rates. The VA reserves the right to request a resident re-assessment at any time during the coverage period.

2. Rate Adjustments: Rate adjustments may be requested by either the VA or the Contractor’s authorized Community Nursing Home (CNH) representative during the term of this IDC. Request for Rate adjustments must be accompanied by a justification for consideration by the Contracting Officer. If approved, the IDC must be modified and signed by both the Contractor and the VA Contracting Officer. The effective date of the rate adjustment will be the actual “Effective Date” as indicated on the IDC or the modification.

3. Rehabilitation Therapy: Any type of rehabilitation therapy (physical therapy, occupational therapy, speech therapy, etc.) requires the pre-approval of the VA before the initiation of therapy.

4. Medications: All Medications administered to VA-contracted Veterans residing in a CNH will be charged at the Average Wholesale Price (AWP) or according to the pharmacy bill, whichever is less. Medication costs up to 8.5% of billed care are included in the RUG rate pricing. Medication costs which exceed 8.5% of the monthly per diem will be billed as a separate line item in addition to the applicable RUG rate(s). All calculations will be made on a monthly basis. When a patient’s medication costs are determined to be in excess of the 8.5%, the VA must be promptly alerted to establish an appropriate course of action. This course of action may include the VA providing medication(s) to the CNH for the contracted Veteran or requiring an acceptable alternative medication be substituted. If for any reason the VA provides patient medications, the rate of reimbursement will be decreased by an agreed upon amount. The VA also reserves the right to deny payment for medication, which at its sole discretion, is determined by the VA to be of no clinical benefit to the veteran.

5. Private Rooms: A private room rate for clinical concerns such as communicable diseases or infections (e.g., MRSA, VRE), or other pertinent clinical needs may be charged above the negotiated RUG rate for that facility with prior approval by the VA CNH Coordinator or designated VA staff. However, no additional private room charge will be allowed in the following circumstances: where the CNH only maintains private rooms; no double-occupancy rooms are available; and for ventilator-dependent patients with prior-negotiated rates.

6. Ventilator Care: Veterans requiring the use of a ventilator will only be placed in a CNH-trained and equipped for those types of specialty patients. The CNH must be inspected and approved by the VA prior to any placements in the ventilator-designated room. Rates for ventilator care will be detailed in the pricing schedule and will be an all-inclusive per diem rate (including ventilator and supplies).

7. Specialized Prosthetics Equipment (e.g., special bed and/or bariatric equipment): Veterans may be eligible for specialized equipment when clinically indicated. Pre-approval required by VA.

Audiology Care

Beds (Specialized)

Dental Care (Extensive)

Dialysis

Durable Medical Equipment

Emergency Room/ Urgent Care Visits

Hospice Care

Hospitalizations

See Schedule of Items (#4)

Medication review as required by NYS regulations

Pre-approval required

Pre-approval required

See Schedule of Items (#5)

Prosthetics (Custom)

Psychology Services

All others need to be pre-authorized

Pre-approval required

Swallowing Evaluation (Diagnostic)

Transportation

See Schedule of Items (#6)

B.3 RUGs IV DESCRIPTIONS Level of Care determinations are based on the Resource Utilization Groups (RUGS-IV) case-mix. A case-mix system categorizes patients into groups according to their level of care needs. RUGS-IV, like other case-mix systems, defines patients for clinical and reimbursement purposes.

Rehabilitation Plus Extensive Services: Residents satisfying all of the following three conditions: Having a minimum activity of daily living (ADL) dependency score of 2 or more. Receiving physical therapy, occupational therapy, and/or speech-language pathology services while a resident. While a resident, receiving complex clinical care and have needs involving tracheostomy care, ventilator/respirator, and/or infection isolation. RUG Scores: RUX, RUL, RVX, RVL, RMX, RHX, RML, RHL, RLX.

Rehabilitation: Residents receiving physical therapy, occupational therapy, and/or speech-language pathology services while a resident. RUG Scores: RUC, RUB, RUA, RVC, RVB, RVA, RHC, RHB, RHA, RMC, RMB, RMA, RLB, RLA.

Extensive Services: Residents satisfying the following two conditions: Having a minimum ADL dependency score of 2 or more. while a resident, receiving complex clinical care and have needs involving tracheostomy care, ventilator/respirator, and/or infection isolation. RUG Scores: ES3, ES2, ES1.

Special Care High: Residents satisfying the following two conditions: Having a minimum ADL dependency score of 2 or more. Receiving complex clinical care or have serious medical conditions involving any one of the following: comatose, septicemia, diabetes with insulin injections and insulin order changes, quadriplegia with a higher minimum ADL dependence criterion (ADL score of 5 or more), chronic obstructive pulmonary disease (COPD) with shortness of breath when lying flat, fever with pneumonia, vomiting, weight loss, or tube feeding meeting intake requirement, parenteral/IV feeding, or respiratory therapy. RUG Scores: HE2, HE1, HD2, HD1, HC2, HC1, HB2, HB1.

Special Care Low: Residents satisfying the following two conditions: Having a minimum ADL dependency score of 2 or more. Receiving complex clinical care or have serious medical conditions involving any of the following: cerebral palsy with ADL dependency score of 5 or more, multiple sclerosis with ADL dependency score of 5 or more, Parkinson’s disease with ADL dependency score of 5 or more, respiratory failure and oxygen therapy while a resident, tube feeding meeting intake requirement, ulcer treatment with two or more ulcers including venous ulcers, arterial ulcers or Stage II pressure ulcers, ulcer treatment with any Stage III or IV pressure ulcer, foot infections or wounds with application of dressing, radiation therapy while a resident, or dialysis while a resident. RUG Scores: LE2, LE1, LD2, LD1, LC2, LC1, LB2, LB1.

Clinically Complex: Residents receiving complex clinical care or have conditions requiring skilled nursing management, interventions or treatments involving any of the following: pneumonia, hemiplegia with ADL dependency score of 5 or more, surgical wounds or open lesions with treatment, burns, chemotherapy while a resident, oxygen therapy while a resident, IV medications while a resident, or transfusions while a resident. RUG Scores: CD1, CE2, CE1, CD2, CC2, CC1, CB2, CB1, CA2, CA1.

Behavioral Symptoms and Cognitive Performance: Residents satisfying the following two conditions: Having a maximum ADL dependency score of 5 or less. Having behavioral or cognitive performance symptoms, involving any of the following: difficulty in repeating words, temporal orientation, or recall (score on the Brief Interview for Mental Status <=9), difficulty in making self-understood, short term memory, or decision making (score on the Cognitive Performance Scale >=3), hallucinations, delusions, physical behavioral symptoms toward others, verbal behavioral symptoms toward others, other behavioral symptoms, rejection of care, or wandering. RUG Scores: BB2, BB1, BA2, BA1.

Reduced Physical Function: Residents whose needs are primarily for support with activities of daily living and general supervision. Calculations identify residents who are receiving restorative nursing services as recorded on the MDS and include: urinary and/or bowel training program, passive and/or active range of motion, amputation/prosthesis, training, splint or brace assistance, dressing or grooming training, eating or swallowing training, transfer training, bed mobility and/or walking training, communication training. RUG Scores: PE2, PE1, PD2, PD1, PC2, PC1, PB2, PB1, PA2, PA1.

B.4 PRICE/COST SCHEDULE

The offeror shall furnish all personnel, professional and technical services, materials, supplies, equipment and qualified supervision as specified herein for off-site community nursing home (CNH) services to eligible beneficiaries of the Veterans Affairs Medical Centers (VAMC) in the New York/New Jersey VA Healthcare Network (VISN 2).

The Government anticipates awarding multiple Indefinite Delivery Indefinite Quantity Contracts (IDIQ) in the following quantities and geographic locations:

· Albany County, New York (3)

· Allegany County, New York (1)

· Bronx County, New York (5)

· Broome County, New York (1)

· Cattaraugus County, New York (3)

· Cayuga County, New York (1)

· Chemung County, New York (1)

· Columbia County, New York (1)

· Erie County, New York (13)

· Franklin County, New York (1)

· Jefferson County, New York (1)

· Lewis County, New York (1)

· Livingston County, New York (1)

· Madison County, New York (1)

· Monroe County, New York (3)

· Nassau County, New York (4)

· Oneida County, New York (3)

· Onondaga, New York (2)

· St. Lawrence, New York (1)

· Steuben, New York (1)

· Suffolk County, New York (4)

· Tompkins County, New York (1)

· Wayne County, New York (1)

· Yates County, New York (1)

Contract type: Fixed Price, Indefinite Delivery Indefinite Quantity Contract (IDIQ) with Economic Price Adjustment (EPA) Authority: Title 38 U.S.C. 1720, Transfer to Nursing Home Care Authority, Federal Acquisition Regulation (FAR) Part 12, Acquisition of Commercial Items in conjunction with FAR Part 15, Contracting by Negotiation.

Place of Performance: Services shall be provided at the offeror’s facility.

Period of Performance: Date of award for one (1) base year with four (4) one-year options to be exercised at the discretion of the Government.

Contract Minimum/Maximum: Multiple awards are anticipated in order to accommodate the various VAMCs and catchment areas in New York State. Veterans will be placed in the facility that most adequately meets their needs. The guaranteed minimum contract amount for any contract awarded as a result of this solicitation is for one Veteran for one bed day of care at the facility’s Medicaid Rate. The maximum contract amount for any contract awarded as a result of this solicitation shall not exceed $6,000,000.00. A task order shall be issued at the start of each period of performance and not by Veteran/patient.

Note: The Government reserves the right to send patients to facilities other than the offeror. VA acknowledges that, depending on the availability of resources during specific times, acceptance of a referral may be commercially impracticable for the CNH. In that event, the CNH may decline to accept an authorization. If the CNH has determined that space is not available and will not accept the Veteran, the VAMC will seek another CNH for placement. In accordance with FAR 16.505(b)(2)(i)(A) or FAR 16.505(b)(2)(i)(B), VA has determined it is in the best interest of the Veteran to place the individual order without further competition because the need for these services is sometimes urgent and providing the opportunity to all CNHs would result in unacceptable delays in fulfilling that need. The CNH will primarily be selected based on the Veteran’s needs and proximity to the Veteran’s home and/or family.

Pricing Instructions: Pricing is based on Medicaid rates. A copy of the Medicaid rate sheet for the Offeror’s facility must be provided.

An IDIQ will be awarded when a patient need has been identified and acceptance of the referral has been made.

If a service is not provided at the offeror’s facility, indicate NA. The same per diem rates shall be used for the base year and all option years in the offeror’s proposal. These per diem rate(s) will apply throughout the term of the IDIQ. However, per diem rate adjustments can be requested by either the VA or an authorized CNH representative at any time (not to exceed one per year).

Rate adjustments are not effective until the IDIQ modification is signed by both the Contractor and the VA Contracting Officer. The effective date of the rate adjustment will be the actual “Effective Date” as indicated on the IDIQ or the modification.

Base Year: (dates TBD upon award)

Option Year 1: (dates TBD upon award)

Option Year 2: (dates TBD upon award)

Option Year 3: (dates TBD upon award)

Option Year 4: (dates TBD upon award)

36C24220R0001

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B.5 PERFORMANCE WORK STATEMENT (PWS)

Overview

1. Federal Acquisition Regulation (FAR) – Indefinite Delivery Indefinite Quantity Contract (IDIQ). In accordance with FAR 16.504, Indefinite-Quantity Contracts, this is an IDIQ from the “Award Date” for one (1) base year with four (4) one-year option periods to be exercised at the sole discretion of the Government.

2. Services Rendered at VA Per Diem Rates. Upon acceptance of a VA patient by the contract nursing home (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.

3. Ordering. 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:

Agency task and delivery order ombudsman (see 16.505(b)(8)) if multiple awards may be made.

A. Background/Introduction

The 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 New York/New Jersey VA Health Care Network (VISN 2) 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. 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.

B. Requirements

1. 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, 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 developed quality of care standards utilizing CMS inspection criteria that are followed by VA in its selection of nursing homes.

VA often has a particular need for specialty care services in the CNH program. 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). Prior to placement of a Veteran, VHA CNH staff (social worker, registered nurse and/or other VHA licensed staff) will determine the CNH resident visit schedule, with input from discharge planning, office of community care and/or other relevant staff. The schedule should consider the particular needs of and services to be provided to the Veteran.

Prior to placement of a Veteran, VHA CNH staff (social worker, registered nurse and/or other VHA licensed staff) will determine the CNH resident visit schedule, with input from discharge planning, office of community care and/or other relevant staff. The schedule should consider the particular needs of and services to be provided to the Veteran.

A Veteran placed with local contract CNH up to one year will be visited by VHA CNH staff at least every 45 days to ensure that clinical, functional and psychosocial needs are assessed, and appropriate interventions instituted to meet those needs. For Veterans in local contract CNH placement longer than one year, the VA medical center chief of staff or designee will determine the frequency of these visits, including potential use of telehealth technologies. The professional discipline of the VHA staff visiting the Veteran will be defined by the visit schedule.

CNH visits are to include review of facility records, interaction with the Veteran and interviews with CNH staff when possible. When Veteran interaction is not possible, interview with involved family member/established caregiver may be used. The CNH resident visit schedule and the results of these visits need to be documented in the Veteran’s VHA electronic medical record by the VHA staff member.

During each CNH resident visit, VHA CNH staff is to make observations about the overall quality of care in the nursing home. Examples include courtesy of staff, adequacy of documentation, social and spiritual activities to promote self-worth and sense of well-being, indications of patient abuse or neglect, and the quality of sensory and environmental aesthetics. Observations and impressions are to be documented for and reviewed by the VA medical center’s CNH Oversight Committee.

If RUG score in Item Z0200 of MDS is PA1 or PA2, or Item Q0500 (Return to Community) is “Yes,” VHA CNH staff will verify a Veteran’s continued need for nursing home level of care and assess for a potential transition to a lower level of care.

Provider visits will be available at the rate of one 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.

Duly authorized representatives of VA will provide quality oversight visits to include potential use of telehealth technologies 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 any way of the responsibility for the daily care and medical treatment of the Veteran.

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 (see Schedule of Items in this IDIQ for details regarding per diem rates and coverage).

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.

2. 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.

3. VA Authorizations. Authorization for nursing home care will be submitted on VA Form 10-7078, “Authorization and Invoice for Medical and Hospital Services,” (https://www.va.gov/vaforms/medical/pdf/VHA-10-7078-fill.pdf). 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.

4. Medicaid-Based Rates. The current State Medicaid 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.

5. 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).

6. 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 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.

a. 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 shall 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.

b. 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 shall be ongoing.

7. Emergency Care; Financial Responsibility; Advanced Directives. In emergencies, nursing home staff will utilize the 911 local emergency systems as for any resident. The VA shall be notified immediately if a Veteran is transferred to a non-VA hospital. 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 as soon as possible but no later than 72 hours of admission on the first business day following a weekend or holiday. This includes the cost of necessary transportation for such care. Advance directives or living wills shall be adhered to according to CNH physician’s orders.

8. 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.

9. 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. Current state licensure is required to be submitted at the time of offers due. Proposals that do not contain the required licensing at the time of offers due shall automatically be rendered technically unacceptable and will not be eligible for award. Changes in the status of the licensure will be immediately reported to the VAMC Home and Community Care Department. VA will monitor the professional care and administrative management of services provided to VA beneficiaries under this IDIQ, through 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 shall make all final determinations as to the Contractor’s reasonable cooperation with VA and compliance with these requirements.

10. 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:

a. Contain elements detailing how the CNH will correct the deficiency as it relates to the individual;

b. Indicate how the CNH will act to protect residents in similar situations;

c. 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;

d. 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

e. Provide dates when corrective action will be completed.

11. 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 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:

a. 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;

b. 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% sprinkled;

c. 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

d. 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.

12. Acceptable Safety and Sanitation Practices. Acceptable safety and sanitation practices shall be observed throughout the facility. The CNH will address employee and patient safety practices through staff orientation, training and adherence to related policy or procedures to provide a safe and clean environment.

13. 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.

a. 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 authorization must be obtained as soon as possible or 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.

b. 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.

c. 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.