36C24418Q0061-001.docx

36C24418Q0061

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 SI

GN 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. SIGN

ATURE 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

595-18-1-CNH-0001

36C24418Q0061 11-22-2017 Herb Byrns 412-822-3740 12-13-2017 36C244 Department of Veterans Affairs Network Contracting Office 4 1010 Delafield Road Pittsburgh PA 15215 x 623110 $27.5 Million N/A X N/A X 36C646 Department of Veterans Affairs Lebanon VA Medical Center Attn:

Gianna Bleyer 1700 South Lincoln Ave Lebanon, PA 17042-7529 PA 15240 36C244 Department of Veterans Affairs Network Contracting Office 4 1010 Delafield Road Pittsburgh PA 15215

Austin Payment Center Department of Veteran Affairs PO Box 149971 Austin TX 78714-8971 877-353-9791 512-460-5545 See CONTINUATION Page Nursing Home Services Basic Ordering Agreement (BOA).

Applicable to onsite VENTILATOR CAPABLE FACILITIES ONLY.

The Contractor shall be responsible for the correct title classification of workers and compliance with all applicable wage and hour laws.

Period of Performance will be Five Years (5) from date of award.

DUE DATE FOR PROPOSALS IS 12/13/2017. HOWEVER, SOLICITATION

TO REMAIN OPEN THROUGH 01/31/2018 IF NOT ALL HOMES

REQUIRED BY GOVERNMENT ARE MET. SEE INSTRUCTIONS TO

OFFERORS IN SECTION E OF THIS SOLICITATION.

See CONTINUATION Page X X x Herb Byrns Table of Contents

SECTION B - CONTINUATION OF SF 1449 BLOCKS

B.1 CONTRACT ADMINISTRATION DATA

(continuation from Standard Form 1449, block 18A.)

1. Contract Administration: All contract administration matters will be handled by the following individuals:

a. CONTRACTOR: TBD

b. GOVERNMENT: Contracting Officer 36C244 Herb Byrns Department of Veterans Affairs Network Contracting Office 4 1010 Delafield Road

Pittsburgh PA 15215

2. CONTRACTOR REMITTANCE ADDRESS: All payments by the Government to the contractor will be made in accordance with:

3. INVOICES: Invoices shall be submitted in arrears:

4. GOVERNMENT INVOICE ADDRESS: All Invoices from the contractor shall be submitted electronically in accordance with VAAR Clause 852.232-72 Electronic Submission of Payment Requests.

Austin Payment Center Department of Veteran Affairs PO Box 149971

Austin TX 78714-8971 ACKNOWLEDGMENT OF AMENDMENTS: The offeror acknowledges receipt of amendments to the Solicitation numbered and dated as follows:

B.2 NURSING HOME PERFORMANCE WORK STATEMENT

A. Overview

1. This Basic Ordering Agreement (BOA) is a written instrument of understanding, negotiated between an agency or contracting activity and a contractor that (1) contains contract clauses applying to future contracts between the parties during its term created by orders placed by the Government and accepted either in writing or by performance by the contractor and (2) contemplates separate future contracts that will incorporate by reference or attachment the required and applicable clauses agreed upon in the BOA. This BOA itself is not a contract. Furthermore, this BOA itself does not, (1) Cite appropriations or obligate funds; (2) State or imply any agreement or guarantee by the Government to place future contracts or orders with the contractor.

2. Federal Acquisition Regulation (FAR) – Basic Ordering Agreements. The BOA is for a time period of five (5) years from the “Award Date”. A binding contract is formed, in accordance with the terms and conditions of this BOA, when the Department of Veterans Affairs (VA) agrees to place a patient in the Community Nursing Home (CNH) and the CNH agrees to accept the patient. Upon acceptance by the Contractor of beneficiaries of VA, all clauses and terms and conditions of this BOA shall apply and become a part of the resultant contract during such time as a VA patient remains in that CNH at the expense of VA.

3. Ordering (Authorization) Process. Location primarily will be selected based on the Veteran’s needs and proximity to the Veteran’s home if space is available. If the BOA holder has determined space is available and has accepted the Veteran, an authorization will be issued. VA acknowledges that, depending on the availability of resources at specific BOA holder facilities at specific times, acceptance of a referral may be commercially impracticable for the BOA holder. In that event, the BOA holder may decline to accept an authorization. The VA’s authorization for nursing home care shall be communicated verbally to the CNH prior to the Veteran’s placement in the CNH only by those VA personnel designated in writing to do so. No entity outside the Lebanon VA Medical Center has authority to admit. If the CNH accepts a Veteran without specific VA approval as previously indicated, neither the VA nor the Veteran will be responsible for payment. The VA’s verbal authorization shall be followed by the corresponding VA Form 10-7078, Authorization and Invoice for Medical and Hospital Services. The VA form 10-7078 will explicitly state the Veteran’s level of care, as well as the beginning and ending dates for which care is authorized to be provided. Any subsequent change to a Veteran’s original authorization shall be immediately communicated via a new authorization to the CNH.

4. Modifications. A BOA shall be changed only by modifying the BOA itself and not by individual orders issued under it. Modifying a BOA shall not retroactively affect orders previously issued under it. See FAR 16.703(c)(2).

5. 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 services specified on the MEDICARE PRICING Table in the Schedule of Items of this BOA. VA rates are generally based on CMS RUGs rates. See Section D.1 (Contract Documents, Exhibits or Attachments) for RUGs Descriptions. VA is only obligated to pay for patients that are placed in accordance with this BOA.

B. 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 Lebanon VA Medical Center at the prices specified in the section titled Schedule of Items of this BOA. 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.

C. 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. Only ventilator capable facilities required. 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. See VHA Handbook 1143.2, “VHA Community Nursing Home Oversight Procedures (June 4, 2004) a copy of which is available at: http://www.va.gov/vhapublications/publications.cfm?pub=2.

VA often has a particular need for specialty care services in the CNH program. The CNH also must be able to accept VA referrals in a timely fashion (ideally within 24 hours of request). 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 veterans placed to assure continuity of care and to assist in the veterans’ transition back into the community when appropriate. 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 BOA will include the cost of nursing care, room and board, meals, primary medical care, one (1) face to face provider visit per month, to include a yearly physical and, as needed, to evaluate any change in Veteran’s condition, drugs and routine supplies, laboratory, x-ray, and other special services pre-authorized by VA, unless otherwise specifically excepted. (See Schedule of Items in this BOA for details regarding per diem rates and coverage).

1. Primary Medical Coverage. The assigned CNH duly licensed physician 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 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). The nursing service shall be under the direct supervision of a full-time, registered professional nurse. 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. The Veteran’s dietary needs shall be met by menus planned to meet his/her nutritional needs and to follow the physician’s diet orders.

2. Specialty Services. The CNH will assume responsibility for arranging specialty care for veterans (e.g., dental care, podiatry and ophthalmology) that are not case managed or arranged through the VA.

3. Outpatient Visits to VA. The CNH is responsible for complying with all rules, policies and regulations expressed by the state in which they operate, as they relate to nursing facilities providing 24 hours per day protective oversight to their residents. Therefore, if a Veteran is sent to an outpatient clinic appointment at the VA, (or admission exam in the VA Emergency Department), the CNH must assure that adequate oversight is provided during the trip to the VA and while the Veteran remains on the VA campus as an outpatient. This oversight may be provided by a staff member, family member, or any other person who, in the judgment of the CNH, can responsibly and capably provide the Veteran with the necessary oversight and assistance with personal care needs. When the Veteran is an outpatient on the VA campus, he is still considered a resident of the nursing facility and the nursing facility is thereby responsible to provide physical assistance and protective oversight. VA reserves the right to send the Veteran back to the CNH without being seen if an escort is not provided, or a signed consent for treatment is needed and is not provided.

4. Transportation. Routine transportation for Veterans under contract is provided by VA only if arranged through the VA, and only if the Veteran has special transportation needs documented, such as being non-ambulatory and requiring a wheelchair or litter for safe transportation. Emergency transportation may be authorized provided VA’s authorization is obtained as soon as possible and not to exceed 72 hours of admission to a VA Medical Center or a non-Federal facility.

5. 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.

6. Medicare-Based Rates. The Resource Utilization Grouping (RUG) rate(s) will include the cost of medical care, medications, laboratory, x-ray, therapy (ies), and other special services pre-authorized by VA, unless otherwise specifically exempted. VA will contract for appropriate Medicare categories of care using Resource Utilization Groups (RUGs-IV) as a reference. A description of the RUGs-IV systems can be found in 42 CFR Parts 409, et al.

7. Medicare Rate Determination. The per diem rate is established by the current Medicare rate for Medicare- approved nursing homes including the cost of supplies, services, and equipment above that is provided under Medicare. Rates established after the Effective Date of this BOA will require a modification to the BOA. The RUGS IV rates include room, board, and routine nursing care, rehabilitation therapy (including physical, speech and occupational therapy), respiratory therapy, oxygen therapy, medical and nursing supplies (including items such as urological and colostomy supplies), most oral medications, most items of durable medical equipment (excluding ventilators), x-rays, and routine laboratory tests (see Schedule of Items in this BOA for details on rates). Any additional requests for payment to the all-inclusive per diem rates must be pre-approved.

8. The CNH’s Minimum Data Set (MDS) Assessment for Medicare: The CNH’s Minimum Data Set (MDS) assessment will be completed on the same schedule as the current Medicare MDS-Scheduled assessments, including close of therapy (COT) assessments. Classification changes will be approved by VA, dependent on projection for short-term or long-term residence, and adhering to the most current MDS frequency guidelines from Medicare. The applicable per diem rate will continue until the next assessment. Classification changes may also occur based on a determination by VA.

9. 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.

10. State Licensure; Access to CNH Quality of Care Reports (QASP Indicator #1). The CNH must maintain a current and unrestricted state license to operate as a skilled nursing facility. Changes in the status of the licensure will be immediately reported to the Lebanon VA Medical Center, Home and Community Care Department at 717/272-6621 extension 4365. VA will monitor the professional care and administrative management of services provided to VA beneficiaries, 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, 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.

11. Corrective Action Plan (QASP Indicator #2): The CNH will cooperate with timely development of Corrective Action Plans (CAPs) related to identified deficiencies from the 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.

12. 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 BOA 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 BOA 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: 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 as soon as practicable. 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.

13. 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.

14. Emergency/Hospital Care (QASP Indicator #3). In emergencies, nursing home staff will utilize the 911 local emergency systems as for any resident. A Veteran who begins to require acute hospital care (or more than the level of care authorized by the VA) may be readmitted to the appropriate VA facility, as determined and authorized by the VA. When such admission is not feasible because of the nature of the emergency, it is agreed that hospitalization in a non-Federal facility may be accomplished provided the VA’s authorization is obtained as soon as possible and not to exceed 72 hours of admission to the non-Federal facility. If hospitalization of a non-emergency nature is required, it is agreed that readmission to a VA facility will be accomplished as soon as the Veteran’s condition is sufficiently stabilized to permit admission. The veteran’s authorization agreement (VA Form 10-7078) will terminate whenever the Veteran is re-hospitalized for 15 calendar days or more in a Federal or non-Federal facility. If, after hospitalization, the Veteran requires nursing home care, a new VA Form 10-7078 shall be communicated to the CNH facility.

15. Bed Holds –If a Veteran receiving care under this agreement is hospitalized from the nursing home, the nursing home and VA facility will arrange to hold a bed in reserve, when such a decision is in the best interest of the Veteran and the VA. The number of covered bed hold days shall be determined by VA on a case-by-case basis, but shall not exceed the number of bed hold days allowed by state regulations, which is 15 days. Bed Hold rate is 1/3 the basic per diem rate. The nursing home is responsible to notify the family if a bed hold is required for a period longer than 15 days. The family would then make arrangements with the home to hold the bed at private pay, if desired.

16. Leave days – The VA may approve leave days (days away from the nursing home) for long-term Veteran placements. The leave must be part of a written therapeutic plan of care, and must be approved in advance by the VA and the CNH physician. Leave days at the VA’s expense are limited to 30 days per Veteran per calendar year, and will be paid at 1/3 the Basic per diem rate. Exceptions may be approved by the VA Community Specialty Services Program Manager or designee.

17. Death of a Veteran- In the event of a Veteran’s death, the CNH will promptly notify the VA within 24 hours or immediately the first business day after a weekend or holiday. The facility will assemble, inventory and safeguard the Veteran’s personal effects pending further guidance by the VA, the Veteran’s family or Power of Attorney.

18. Reportable Events (QASP Indicator #4). 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: 1) sentinel events; 2) when there is a pending change of ownership of the CNH; 3) when there is a change of nursing home administrator or Director of Nursing/Director of Nursing Service; 4) substantiated allegations of mistreatment, neglect, abuse or misappropriation of CNH veteran’s property; 5) elopements of CNH veterans pursuant to state regulations; 6) infectious outbreaks; 7) resident to resident or resident to staff altercations involving a CNH veteran resulting in any injury that is other than minor; 8) copies of annual surveys or substantiated complaint investigations conducted by a State oversight agency; and 9) 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: 1) a fall resulting in death or injury; 2) elopement resulting in a missing patient; 3) patient abuse confirmed or under suspicion; 4) a medication error resulting in patient illness or injury; 5) death or patient injury related to restraint (including side rails) use; or 6) 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 office. 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 office.

19. Exclusion Criteria- A CNH may be excluded from the VA’s CNH Program participation when any four of these seven factors are present in the current Office of Health Facility Licensure and Certification (OHFLAC) or CMS database:

20. 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:

21. VA Staff Access to CNH Records (QASP Indicator #5). All medical records concerning the veteran’s care in the CNH will be readily accessible to VA. Upon discharge or the death of a patient, medical records will be retained by the CNH for a period of at least five (5) years following termination of care. Patient records will be maintained in conformance with the Privacy Act of 1974 (5 U.S.C. § 552a). A medical record shall be maintained for each patient, which includes at least the following:

a. Admission Identification record

b. Admitting evaluation (Including diagnosis) by the CNH physician

c. Physician orders

d. Progress notes (the physician orders/notes shall be charted immediately after patient is seen)

e. Special reports (laboratory tests, X-rays, activity, etc.)

f. Minimum Data Set (MDS) information

g. Advance Directive and/or appropriate documentation

h. Person to contact in an emergency situation;

i. Name of attending medical practitioner;

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.

22. 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.

23. CNH Billing (QASP Indicator #6). Invoices for board, care and ancillary services shall be submitted promptly to the authorizing facility by the 15th calendar day following the end of the month in which services were rendered. The CNH will promptly notify the VA CNH Coordinator regarding any change in Veteran status: discharge, transfer, against medical advice (AMA), hospitalization, death and/or any changes in payer source and any ability to complete timely billing. All invoices must include the full name and address of the CNH and shall reflect the patient’s name, social security number, number of days billed, and agreed upon RUG rate (s). Failure to include this information may result in delayed payment.

24. VA Authorizations. It is impossible to determine the exact or estimated amount, which will be expended under this BOA. No obligation will be incurred by VA under this BOA, 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 BOA. 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.

25. VA Payments. Payments made by VA under any contract pursuant to this BOA, constitute the total cost of nursing home care. No additional charges will be billed to Medicare (with the exception of hospice), Medicaid, or private insurance, the beneficiary or his/her family, either by the CNH or any third party furnishing services or supplies required for such care, unless and until specific prior authorization in writing is obtained from the VA facility authorizing placement. The patient, family and any other entitlement programs (e.g., Medicare, Medicaid, etc.) will not be billed for uncovered services or costs during the VA contract period. This constitutes double-billing and Federal fraud.

END PERFORMANCE WORK STATEMENT

B.3 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. Items generally included or excluded in the per diem rate are listed in Table A, although some variances may apply in coverage. The per diem rate(s) will apply throughout the term of this BOA. While the VA uses Medicare or State Medicaid rates as a reference, VA rates are independent of those payment systems and governed by the terms of this BOA. The per diem rate utilizes the Medicare RAI/MDS assessment and RUGS score as the reference for rates. Assessment schedules identical to Medicare will be used; in addition, the VA reserves the right to request a resident re-assessment at any time during the coverage period.

A. Rate Adjustments: Rate adjustments can be requested by either the VA or an authorized Community Nursing Home (CNH) representative of the Contractor at any time or at least on an annual basis during the term of this BOA. Rate adjustments are not effective until the BOA 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 BOA or the modification.

B. 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. Therapy must be ordered by a VA physician for a specific period of time, not to exceed 1 month. 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. Orders may be recertified and notes must be sent to VA with each new request. The Rehabilitation rate will be paid for the first seven days of a Veteran’s admission in order to prevent delay in care, unless determination of a reduced level of care is made sooner. Thereafter, prior to the initiation of any therapy, the CNH must provide the VA Community Specialty Services Program Manager with a complete initial assessment for each therapeutic program which is to be performed at the CNH. The initial assessment for each therapy must be performed by a licensed therapist and may not be charged to the VA.

a. Initial approval for therapy will be for a period not to exceed four weeks.

b. Therapy will be provided for a minimum of 325 minutes per week.

c. Copy of the summarized therapy notes and updated MDS will be sent to the VA at the end of the authorized time period.

d. Orders may be reauthorized by the VA if continued therapy is determined to be needed.

e. Therapies must be delivered concurrently when appropriate.

C. Medications: All Medications administered to VA-contracted Veterans residing in a CNH will be charged at the 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. High cost drugs: All requests for additional reimbursement for high cost drugs must be pre-approved by Program Manager.

D. 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 only be charged above the negotiated RUG rate for that facility with prior approval and modification of the BOA. 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.

E. 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 rate table and will be an all-inclusive per diem rate (including ventilator and supplies).

F. 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.

G. Respite Care: A Veteran accepted for admission under Respite Care will receive the same level of care, and at the same frequency, as all other residents of the CNH facility. The rate for Respite Care reimbursement will be at the Basic/Behavioral Problems/Impaired Cognition VA per diem rate established in the current BOA pricing schedule. For Respite Care Veterans no rehabilitative related therapy evaluations or services will be granted unless specifically authorized in advance. When CNH policy allows, Veterans should be permitted to provide medication from home for use during their stay. If not, only the amount of medication needed to cover their respite stay will be ordered from in-house pharmacy.

Schedule A

Pre-approval required

Pre-approval required

Pre-approval required

B.3.1C.

Durable medical Equipment

Specialized beds

Hospice Care

Dialysis

Transportation

UC/ER visits

Hospitalizations

Psychology Services

Pre-approval and special authorization required for NON ROUTINE DENTAL

Audiology Care

Pre-approval and special authorization required for NON ROUTINE EYE CARE

Custom Prosthetics

B4. MEDICARE PRICING TABLE

Medicare Resource Utilization Group (RUG) rates have 66 Levels of Care, the Department of Veteran Affairs anticipates determining rates based on 8 blended categories’ comprised of the following.

Source: Federal Register RUGS IV Pricing Schedule

Per Diem Rate

inclusive of: RUX, RUL, RVX, RVL, RHX, RHL, RMX, RML,RLX

inclusive of: RUC, RUB, RUA, RVC, RVB, RVA, RHC, RHB, RHA, RMC, RMB, RMA, RLB, RLA

inclusive of: ES3, ES2, ES1

inclusive of: HE2, HE1, HD2, HD1, HC2, HC1, HB2, HB1

inclusive of: LE2, LE1, LD2, LD1, LC2, LC1, LB2, LB1

inclusive of: CE2, CE1, CD2, CD1, CC2, CC1, CB2, CB1, CA2, CA1

inclusive of: BB2, BB1, BA2, BA1

inclusive of: PE2, PE1, PD2, PD1, PC2, PC1, PB2, PB1, PA2, PA1

All Inclusive VA Per Diem Rates include the following: Drugs, Supplies, Oxygen, X-Ray, Laboratory, Physicians visits, Respiratory Therapies, and Rental Equipment.

SECTION C - CONTRACT CLAUSES

C.1 52.212-4 CONTRACT TERMS AND CONDITIONS—COMMERCIAL ITEMS (MAY 2015)

(a) Inspection/Acceptance. The Contractor shall only tender for acceptance those items that conform to the requirements of this contract. The Government reserves the right to inspect or test any supplies or services that have been tendered for acceptance. The Government may require repair or replacement of nonconforming supplies or reperformance of nonconforming services at no increase in contract price. If repair/replacement or reperformance will not correct the defects or is not possible, the Government may seek an equitable price reduction or adequate consideration for acceptance of nonconforming supplies or services. The Government must exercise its post-acceptance rights—

(1) Within a reasonable time after the defect was discovered or should have been discovered; and

(2) Before any substantial change occurs in the condition of the item, unless the change is due to the defect in the item.

(b) Assignment. The Contractor or its assignee may assign its rights to receive payment due as a result of performance of this contract to a bank, trust company, or other financing institution, including any Federal lending agency in accordance with the Assignment of Claims Act (31 U.S.C. 3727). However, when a third party makes payment (e.g., use of the Governmentwide commercial purchase card), the Contractor may not assign its rights to receive payment under this contract.

(c) Changes. Changes in the terms and conditions of this contract may be made only by written agreement of the parties.

(d) Disputes. This contract is subject to 41 U.S.C. chapter 71, Contract Disputes. Failure of the parties to this contract to reach agreement on any request for equitable adjustment, claim, appeal or action arising under or relating to this contract shall be a dispute to be resolved in accordance with the clause at FAR 52.233-1, Disputes, which is incorporated herein by reference. The Contractor shall proceed diligently with performance of this contract, pending final resolution of any dispute arising under the contract.

(e) Definitions. The clause at FAR 52.202-1, Definitions, is incorporated herein by reference.

(f) Excusable delays. The Contractor shall be liable for default unless nonperformance is caused by an occurrence beyond the reasonable control of the Contractor and without its fault or negligence such as, acts of God or the public enemy, acts of the Government in either its sovereign or contractual capacity, fires, floods, epidemics, quarantine restrictions, strikes, unusually severe weather, and delays of common carriers. The Contractor shall notify the Contracting Officer in writing as soon as it is reasonably possible after the commencement of any excusable delay, setting forth the full particulars in connection therewith, shall remedy such occurrence with all reasonable dispatch, and shall promptly give written notice to the Contracting Officer of the cessation of such occurrence.

(g) Invoice.

(1) The Contractor shall submit an original invoice and three copies (or electronic invoice, if authorized) to the address designated in the contract to receive invoices. An invoice must include—

(i) Name and address of the Contractor;

(ii) Invoice date and number;

(iii) Contract number, contract line item number and, if applicable, the order number;

(iv) Description, quantity, unit of measure, unit price and extended price of the items delivered;

(v) Shipping number and date of shipment, including the bill of lading number and weight of shipment if shipped on Government bill of lading;

(vi) Terms of any discount for prompt payment offered;

(vii) Name and address of official to whom payment is to be sent;

(viii) Name, title, and phone number of person to notify in event of defective invoice; and

(ix) Taxpayer Identification Number (TIN). The Contractor shall include its TIN on the invoice only if required elsewhere in this contract.

(x) Electronic funds transfer (EFT) banking information.

(A) The Contractor shall include EFT banking information on the invoice only if required elsewhere in this contract.

(B) If EFT banking information is not required to be on the invoice, in order for the invoice to be a proper invoice, the Contractor shall have submitted correct EFT banking information in accordance with the applicable solicitation provision, contract clause (e.g., 52.232-33, Payment by Electronic Funds Transfer—System for Award Management, or 52.232-34, Payment by Electronic Funds Transfer—Other Than System for Award Management), or applicable agency procedures.

(C) EFT banking information is not required if the Government waived the requirement to pay by EFT.

(2) Invoices will be handled in accordance with the Prompt Payment Act (31 U.S.C. 3903) and Office of Management and Budget (OMB) prompt payment regulations at 5 CFR part 1315.

(h) Patent indemnity. The Contractor shall indemnify the Government and its officers, employees and agents against liability, including costs, for actual or alleged direct or contributory infringement of, or inducement to infringe, any United States or foreign patent, trademark or copyright, arising out of the performance of this contract, provided the Contractor is reasonably notified of such claims and proceedings.

(i) Payment.—

(1) Items accepted. Payment shall be made for items accepted by the Government that have been delivered to the delivery destinations set forth in this contract.

(2) Prompt payment. The Government will make payment in accordance with the Prompt Payment Act (31 U.S.C. 3903) and prompt payment regulations at 5 CFR part 1315.

(3) Electronic Funds Transfer (EFT). If the Government makes payment by EFT, see 52.212-5(b) for the appropriate EFT clause.

(4) Discount. In connection with any discount offered for early payment, time shall be computed from the date of the invoice. For the purpose of computing the discount earned, payment shall be considered to have been made on the date which appears on the payment check or the specified payment date if an electronic funds transfer payment is made.

(5) Overpayments. If the Contractor becomes aware of a duplicate contract financing or invoice payment or that the Government has otherwise overpaid on a contract financing or invoice payment, the Contractor shall—

(i) Remit the overpayment amount to the payment office cited in the contract along with a description of the overpayment including the—

(A) Circumstances of the overpayment (e.g., duplicate payment, erroneous payment, liquidation errors, date(s) of overpayment);

(B) Affected contract number and delivery order number, if applicable;

(C) Affected contract line item or subline item, if applicable; and

(D) Contractor point of contact.

(ii) Provide a copy of the remittance and supporting documentation to the Contracting Officer.

(6) Interest.

(i) All amounts that become payable by the Contractor to the Government under this contract shall bear simple interest from the date due until paid unless paid within 30 days of becoming due. The interest rate shall be the interest rate established by the Secretary of the Treasury as provided in 41 U.S.C. 7109, which is applicable to the period in which the amount becomes due, as provided in (i)(6)(v) of this clause, and then at the rate applicable for each six-month period as fixed by the Secretary until the amount is paid.

(ii) The Government may issue a demand for payment to the Contractor upon finding a debt is due under the contract.

(iii) Final decisions. The Contracting Officer will issue a final decision as required by 33.211 if—

(A) The Contracting Officer and the Contractor are…