36C24520R0022-0001008.pdf

PAGE 1 OF 81 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

36C24520R0022 01-13-2020

JABBAR PRINGLE/CONTRACT OFFICER (304)263-0811 x2031 09-01-2020

Department of Veterans Affairs

VA Maryland Health Care System

510 Butler Ave

Martinsburg WV 25401

X

623110

N/A

X

Louis A Johnson VAMC

1 Med Center Drive

Clarksburg WV 26301

510 Butler Ave

Martinsburg WV 21902

PAYMENT WILL BE MADE USING VA FORM 1358.

THE VA USES VA FORM 1358 AS AN OBLIGATION

CONTROL DOCUMENT FOR CONTRACTS THAT

AWARDED FOR COMMUNITY NURSING HOME

SERVICES.

See CONTINUATION Page

TO PROVIDE COMUNNITY NURSING HOME SERVICES FOR THE

LOUIS A. JOHNSON VETERANS AFFAIRS MEDICAL CENTER.

PLEASE SEE PAGE 21 FOR PERIOD OF PERFORMANCE AND

PRICE SCHEDULE.

CONTRACTOR IS RESPONSIBLE FOR CORRECT WAGE TITLES AND

COMPLIANCE WITH ALL APPLICABLE WAGE AND HOUR LAWS.

See CONTINUATION Page

X X

X 1

JABBAR PRINGLE

36C24520R0022

Table of Contents

SECTION A

A.1 SF 1449 SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL ITEMS

SECTION B - CONTINUATION OF SF 1449 BLOCKS

B.1 CONTRACT ADMINISTRATION DATA

B.2 CONTRACTOR RESPONSIBILITY

B.3 SCHEDULE OF ITEMS

B.4 INDEMNITY

B.5 PERFORMANCE WORK STATEMENT

B.6 PRICE/COST SCHEDULE

B.7 ACCEPTABLE SAFETY AND SANITATION PRACTICES

B.8 MEDICARE/MEDICAID STANDARDS

B.9 INVOICES…………………………………………………………………………………..24

B.10 AUTHORIZATIONS………………………………………………………………………24

B.11 ANCILLARY COST……………………………………………………………………….24

B.12 ECONOMIC PRICE ADJUSTMENT

B.13 TERMINATION OF SERVICES

B.14 PAYMENTS

SECTION C - CONTRACT CLAUSES

C.1 52.212-4 CONTRACT TERMS AND CONDITIONS—COMMERCIAL ITEMS (OCT

2018)

C.2 52.203-16 PREVENTING PERSONAL CONFLICTS OF INTEREST DEC 2011

C.3 52.203-17 CONTRACTOR EMPLOYEE WHISTLEBLOWER RIGHTS AND

REQUIREMENT TO INFORM EMPLOYEES OF WHISTLEBLOWER RIGHTS (APR 2014)

C.4 52.204-4 PRINTED OR COPIED DOUBLE-SIDED ON POSTCONSUMER FIBER

CONTENT PAPER (MAY 2011)

C.5 52.204-9 PERSONAL IDENTITY VERIFICATION OF CONTRACTOR PERSONNEL

(JAN 2011)

C.6 52.204-18 COMMERCIAL AND GOVERNMENT ENTITY CODE MAINTENANCE

(JUL 2016)

C.7 52.216-18 ORDERING (OCT 1995)

C.8 52.216-19 ORDER LIMITATIONS (OCT 1995)

C.9 52.216-22 INDEFINITE QUANTITY (OCT 1995)

C.10 52.217-8 OPTION TO EXTEND SERVICES (NOV 1999)

C.11 52.224-1 PRIVACY ACT NOTIFICATION (APR 1984)

C.12 52.224-2 PRIVACY ACT (APR 1984)

C.13 52.232-19 AVAILABILITY OF FUNDS FOR THE NEXT FISCAL YEAR (APR 1984)

C.14 52.237-3 CONTINUITY OF SERVICES (JAN 1991)

C.15 VAAR 852.203-70 COMMERCIAL ADVERTISING (MAY 2018)

C.16 VAAR 852.216-73 ECONOMIC PRICE ADJUSTMENT—STATE NURSING HOME

CARE FOR VETERANS (MAR 2018)

C.17 VAAR 852.232-72 ELECTRONIC SUBMISSION OF PAYMENT REQUESTS (NOV

2018)

C.18 VAAR 852.237-70 INDEMNIFICATION AND MEDICAL LIABILITY INSURANCE

(OCT 2019)

C.19 MANDATORY WRITTEN DISCLOSURES

C.20 52.212-5 CONTRACT TERMS AND CONDITIONS REQUIRED TO IMPLEMENT

STATUTES OR EXECUTIVE ORDERS—COMMERCIAL ITEMS (OCT 2019)

SECTION D - CONTRACT DOCUMENTS, EXHIBITS, OR ATTACHMENTS

D.1 QUALITY ASSURANCE SURVEILLANCE PLAN

D.2 CONTRACTOR RULES OF BEHAVIOR

D.3 ORGANIZATIONAL CONFLICT OF INTEREST

D.4 CONTRACTOR CERTIFICATION: IMMIGRATION AND NATIONALITY ACT OF

1952, AS AMENDED

D.5 WAGE DETERMINATION

D.6 DEPARTMENT OF VETERANS AFFAIRS (VA) COMMUNITY NURSING HOME

PROGRAM LEVEL OF CARE – DESCRIPTIONS-RUG III

D.7 RUG-IV DESCRIPTIONS

SECTION E - SOLICITATION PROVISIONS

E.1 52.212-1 INSTRUCTIONS TO OFFERORS—COMMERCIAL ITEMS (OCT 2018)

E.2 52.204-7 SYSTEM FOR AWARD MANAGEMENT (OCT 2018)

E.3 52.204-16 COMMERCIAL AND GOVERNMENT ENTITY CODE REPORTING (JUL

2016)

E.4 52.204-24 REPRESENTATION REGARDING CERTAIN TELECOMMUNICATIONS

AND VIDEO SURVEILLANCE SERVICES OR EQUIPMENT (AUG 2019)

E.5 52.209-7 INFORMATION REGARDING RESPONSIBILITY MATTERS (OCT 2018)

E.6 52.216-1 TYPE OF CONTRACT (APR 1984)

E.7 52.216-27 SINGLE OR MULTIPLE AWARDS (OCT 1995)

E.8 52.233-2 SERVICE OF PROTEST (SEP 2006)

E.9 VAAR 852.233-70 PROTEST CONTENT/ALTERNATIVE DISPUTE RESOLUTION

(OCT 2018)

E.10 VAAR 852.233-71 ALTERNATE PROTEST PROCEDURE (OCT 2018)

E.11 52.212-2 EVALUATION—COMMERCIAL ITEMS (OCT 2014)

E.12 52.212-3 OFFEROR REPRESENTATIONS AND CERTIFICATIONS—COMMERCIAL

ITEMS (OCT 2018)

SECTION B - CONTINUATION OF SF 1449 BLOCKS

B.1 CONTRACT ADMINISTRATION DATA

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

a.

b. GOVERNMENT: Contract Officer/Jabbar Pringle

Network Contracting Office 5

510 Butler Ave

Martinsburg, WV 25401

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

[X] 52.232-33, Payment by Electronic Funds Transfer—System for Award Management, or

[] 52.232-36, Payment by Third Party

3. INVOICES: Invoices shall be submitted in arrears:

a. Quarterly []

b. Semi-Annually []

c. Other [X] Monthly

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.

PAYMENT WILL BE MADE USING A 1358 FORM.

CONTRACTOR

ADDRESS

POINT OF

CONTACT

PHONE

NUMBER

EMAIL

DUNS

NUMBER

ACKNOWLEDGMENT OF AMENDMENTS: The offeror acknowledges receipt of amendments to the

Solicitation numbered and dated as follows:

AMENDMENT NO DATE

B.2 CONTRACTOR RESPONSIBILITY

Information Regarding Contractor Performance Assessment Reporting System (CPARS) -

CONTRACTOR'S Responsibility

This contract will require reporting by the Veterans Health Administration (VHA) in the

Contractor Performance Assessment Reporting System (CPARS); therefore, at the time of award the contractor shall provide to the Contracting Officer a Point-of-Contract (POC) individual who will be responsible for managing reports within CPARS on this contract and will be assigned the role as

"contractor representative" (CR) within CPARS.

CPARS is a Federal-agency wide system for the collection of Contractor Past Performance Information

(PPI). Reporting PPI through CPARS is being implemented throughout VHA to be in compliance with the requirements of FAR Part 42 for documenting contractor performance assessments and evaluations.

PPI is relevant information for future source selection purposes regarding a contractor's actions under previously awarded contracts. It includes, for example, the contractor's record of conforming to contract requirements and to standards of good workmanship; the contractor's record of forecasting and controlling costs; the contractor's adherence to contract schedules, including the administrative aspects of performance; the contractor's history of reasonable and cooperative behavior and commitment to customer satisfaction; the contractor's record of integrity and business ethics, and, generally, the contractor's business-like concern for the interest of the customer. Reporting PPI through CPARS facilitates compliance with the requirements of Office of Federal Procurement Policy (OFPP) memorandum, “Improving the Collection and Use of Information about Contractor Performance and

Integrity".

After award, the contractor's CR will receive an email notification that access to the contract has been given to them. The CR should ensure that their contact information is accurate in CPARS at http://www.cpars.gov. The Contracting Officer/Contracting Officer Representative will evaluate the contractor’s performance throughout the life of the contract, generally every 365 days, and at the end of contract performance. The report shall, then, be assigned in CPARS to the contractor's designated CR for comment.

The contractor's CR will have up to 60 days to submit any comments and then re-assign the report to the

VA Contracting Officer/contract specialist acting as the Assessing Official within CPARS. Failure to register and respond within the 60 days will result in the Government’s evaluation being placed on file in the database with a statement that the contractor failed to respond. The contractor should note that the government's evaluation will appear in the Past Performance Information Retrieval System (PPIRS) on day 15 in a pending status if the CR has not commented by day 15. After the CR has either commented or failed to respond within 60 days, the evaluation will become final in PPIRS.

It is the responsibility of the contractor to contact the contracting officer and request a change if, at any time, the contractor wishes to change the person assigned as the contractor representative on this contract.

In order to ensure the timely completion of contractor performance evaluations within the Contractor

Performance

Assessment Reporting System (CPARS), the following individuals are assigned these specific roles within the system:

Assessing Official's Representative - (person from the requiring activity responsible for writing the

CPAR/report and rating the contractor's performance): Rebecca.Lambert@va.gov

Assessing Official- (Contracting Officer/contract specialist responsible to act as a check and balance and review, sign, and send the CPAR/report to the Contractor Representative): Jabbar Pringle, Contracting

Officer; Jabbar.Pringle@va.gov

Contractor Representative- (person from the contractor's office with the responsibility of receiving, reviewing and/or commenting on the reports/assessments): [Please provide the name of your contractor representative]

Training for all persons responsible for the preparation and review of performance assessments is available online at: https://www.cpars.gov by clicking on the tab "Training".

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. The per diem rate(s) will apply throughout the term of this

Indefinite Delivery Contract (IDC). 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 IDC.

The per diem rate utilizes the Medicare Resident Assessment Instructions (RAI)/Minimum Data Set

(MDS) assessment and Resource Utilization Groups (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.

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. Any rate adjustment shall not exceed the Medicare rate.

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). Any rate adjustment shall not exceed the Medicare rate.

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.

B.4 INDEMNITY

The Contractor shall be liable for, and shall indemnify and hold harmless the Government against, all actions or claims for loss of or damage to property or the injury or death of persons, arising out of or resulting from the fault, negligence, or act or omission of the Contractor, its agents, or employees.

B.5 PERFORMANCE WORK STATEMENT

A. Overview

1. Federal Acquisition Regulation (FAR) – Indefinite Delivery Contract (IDC). In accordance with FAR 16.504, Indefinite-Quantity Contracts, this is a five (5) year IDC from time of award.

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

CNH, if and when requested by the VA Contracting Officer or authorized representative, the

Contractor shall furnish all supplies and services herein described, at the per diem rates for the”

Levels of Care” specified in the Schedule of Items of this IDC. The VA “Levels of Care” are defined in an attachment in Section D.1 of the solicitation and the IDC. VA is obligated only to the extent authorized placement of patients is made in accordance with this IDC.

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:

Ordering Officer Name: Rebecca Lambert

Address One Medical Drive; Clarksburg, WV 26301

Telephone number 304-623-7651

E-mail address Rebecca.lambert@va.gov

Facsimile number 304-626-7007

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

B. Background/Introduction. The Community Nursing Home (CNH) program is a key component of the Veterans Health Administration (VHA) continuum of care. The

Contractor agrees to provide in accordance with the terms and conditions stated herein to the U.S. Department of Veterans Affairs Louis A. Johnson VA Medical Center in

Clarksburg, West Virginia at the prices specified in the section titled Schedule of Items of this IDC. 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

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 https://www.acquisition.gov/far/current/html/Subpart%2016_5.html#wp1095799 mailto:Rebecca.lambert@va.gov https://www.acquisition.gov/sites/default/files/current/far/html/Subpart%2016_5.html#wp1095799 license. VA developed quality of care standards utilizing CMS inspection criteria that are followed by VA in its selection of nursing homes which includes exclusionary criteria on which the CNH is evaluated. 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 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 will be available 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. Duly authorized representatives of VA will provide quality oversight visits to veterans placed to assure continuity of care and to assist in the veterans’ transition back into the community. These visits do not substitute nor relieve the CNH in any way of the responsibility for the daily care and medical treatment of the veteran. The per diem rate(s) established in this IDC will include the cost of primary medical care, one (1) provider visit per month and needed consultation, drugs and routine supplies, laboratory, x-ray, and other special services authorized by VA, unless otherwise specifically excepted (see Schedule of Items in this

IDC 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.” 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. 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 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.

5. 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 provided under Medicare. Rates established after the Effective Date of this IDC will require a modification to the IDC. 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 IDC for details on rates). Any additional requests for payment to the all-inclusive per diem rates must be pre-approved.

http://www.va.gov/vhapublications/publications.cfm?pub=2

6. 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. This request should be submitted on the Level of Care Authorization Form provided to the facility. VA will make the determination whether classification changes require readmission to VA. VA staff will audit approximately 20% of the MDS assessments.

The Level of Care classification and associated per diem rates will remain in effect for each placement until and unless one of the following events takes place:

a. Re-hospitalization that may be associated with a change in level of care;

b. Need for more intensive therapy;

c. Significant change in condition; or

d. Classification changes may also occur based on a determination by VA.

7. 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).

8. Rehabilitation Criteria. All therapy provided under this IDC 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 should describe objective measurements which, when compared, show improvements in function, or decrease in severity, or justification for an optimistic outlook to justify continued treatment.

Covered therapy services shall be rehabilitative therapy services unless they meet the criteria for maintenance therapy requiring the skills of a therapist.

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 should be ongoing.

9. Emergency Care; Financial Responsibility; Advanced Directives. In emergencies, nursing home staff will utilize the 911 local emergency systems as for any resident. Advance directives or living wills shall be adhered to according to CNH physician’s orders. When private hospitalization or emergency services are required, the patient, spouse, financial guardian or insurer 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 within 72 hours of admission on the first business day following a weekend or holiday. This includes the cost of necessary transportation for such care.

10. 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.

11. 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 Louis A.

Johnson VA Medical Centers Community Nursing Home program 304-623-7651. VA will monitor the professional care and administrative management of services provided to VA beneficiaries under this IDC, 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 IDC, 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.

12. 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.

13. 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 IDC 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 IDC 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% sprinklered;

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 the time of renovation or alteration.

14. 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.

15. 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 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 IDC, 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. In these cases, the CNH will forward an inventory of any such property and funds in its possession to the VA facility authorizing admission and will hold them (except articles of clothing necessary for proper burial) under safeguard until instructions are received from VA concerning disposition. CMS regulations require retention of records for five (5) years when there is no requirement in State law.

16. Leave of Absence (LOA) – Bed-Hold Statement. For re-hospitalizations or therapeutic passes, VA will pay a bed hold. Any bed-hold charge shall not exceed the number of bed-hold days allowed by state regulations. Therapeutic passes will be authorized by the CNH staff based on individual patient needs but are generally limited to two (2) times per month and should be pre-approved. VA will cover bed holds based on the following plan:

The host VA medical center will select one of the following options:

a. 3 days/episode, pre-approved by the Louis A. Johnson VAMC when in the best interest of the Veteran and VAMC. Exceptions will be approved at VAMC level

Bed-hold will begin the date the resident leaves the CNH and full per diem will resume on the date of readmission to the CNH. Absences of fifteen (15) consecutive calendar days or more, whether in a VA or in a non-Federal facility require a new authorization agreement. The nursing home is responsible to notify the family if a bed hold is required for a longer period. The family would then make arrangements with the home to hold the bed.

17. 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 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 veterans or 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.

18. VA Actions Regarding Serious Quality of Care Deficiencies. In cases of serious deficiencies affecting the health or safety of veterans or in cases of continued uncorrected deficiencies, VA will take one or more of the following actions in accordance with the terms and clauses of the IDC and applicable procurement regulations:

a. Increase VA staffing monitoring until the State survey agency clears the deficiency;

b. Suspend placement of veterans in the CNH;

c. Remove or transfer veterans under the IDC from the subject CNH;

d. Not renew the IDC; and/or

e. Terminate the IDC.

19. 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. VAHCS Referral Package to the CNH:

1. Copy of Physician Orders for Nursing Home Care; CPRS Notes; Discharge

Summary including History & Physical information with Medication List;

Rehabilitation

Progress Notes; and Veteran Demographic Record which includes next of kin information.

2. Copy of Authorization Agreement (VAF 10-7078).

b. Nursing Home Clinical Record: The CNH must maintain clinical records on each veteran in accordance with accepted professional standards and practice. The clinical record must be: complete, accurately documented, readily accessible, systematically organized, and legible. Clinical records must contain at a minimum:

1. Sufficient information to identify the resident;

2. A record of the veteran’s assessments, including those assessments performed by services under the IDC with the CNH;

3. The plan of care and services including medication administration, provided by CNH staff and services provided under the IDC with the CNH;

4. Interdisciplinary progress notes to include effect of care provided, veterans’ response to treatment, change in condition, and changes in treatment;

5. Medical practitioner orders which are signed and dated;

6. Allergies;

7. Person to contact in an emergency situation;

8. Name of attending medical practitioner; and

9. Advanced directives if available.

c. 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.

20. Specialty Services. The CNH will assume responsibility for arranging specialty care for veterans (e.g., dental care, podiatry and ophthalmology).

21. VA Medical Center Consultation/Resources.

(a) When Veteran requires ambulance transport to a Community Hospital Emergency

Department

a. During work hours: Contact Care in the Community at 304-623-3461 ext. 2640

b. After work hours: Contact Administrative Officer of the Day (AOD) at 304-623-

3461 ext. 3215

c. The Transferring nursing home is to inform the receiving emergency department the patient is a Veteran and following stabilization the Veteran is to be transported to the closest VA medical center. If not the LAJVAMC, then we are to be notified.

(b) When Veteran requires admission to a Community Hospital

a. Follow above protocol

(c) When the Veteran requires ambulance transport to this VAMC

a. Follow above protocol

b. NOTIFY VAMC EMERGENCY DEPARTMENT STAFF OF REASON FOR

TRANSPORT AND EXPECTATIONS OF CARE.

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, RUG category (ies), and agreed upon RUG rate (s). Failure to include this information may result in delayed payment.

a. Pre-approved services billed by CMS procedures or CPT codes: All services which are pre-approved by VA as additional to the all-inclusive per diem rate must be billed according to CMS procedures or CPT codes. The CNH will be reimbursed based on local guidelines and VA pricing schedules.

b. High cost drugs: All requests for additional reimbursement for high cost drugs and corresponding billing are due as soon as possible, but no later than 90 calendar days after use of products.

c. Invoices: Corrected invoices must be submitted for additional payment of any ancillary costs or changes to the original billing. All corrected invoices must include all items that are affected by the change.

Any rate adjustment shall not exceed the Medicare rate.

24. Minimum Quantities; VA Payment. The guaranteed minimum quantity to be awarded under this contract is one (1) night stay per veteran and the maximum quantity to be awarded under this contract is $5,000,000.00. 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 IDC. 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 IDC, 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.

a) Vendors who bill electronically using the HIPAA-compliant claims transactions must submit claims through the VA clearinghouse, Emdeon, using payer ID number 12115 for medical claims.

b) Vendors who are not able to use the HIPAA-compliant transactions are not required to do so. Supporting information for monthly invoices will be mailed to:

LAJVAMC

Attn: Community Nursing Home Program-Rosebud Plaza

One Medical Center Drive

Clarksburg, WV 26301

B.6 PRICE/COST SCHEDULE

*The guaranteed minimum quantity to be awarded under this contract is one (1) night stay per veteran and the maximum quantity to be awarded under this contract is $5,000,000.00. *

Period of Performance Total Annual Cost

Five (5) Year IDIQ: TBD Contractor will invoice at the rates included in the

“Medicare RUGS IV Pricing Schedule” below. Any changes to the Medicare rates must be issued by CO through a modification document.

**The period of performance will be added prior to award of contract**

Medicare RUGS IV Pricing Schedule

Line Item RUGS IV Category Description Medicare

Base

Rate

Percentage

Discount

Medicare Per

Diem Rate

1 RUX – Extensive Services criteria + RU

Criteria – ADL 16 - 18

2 RUL - Extensive Services criteria

+ RU Criteria – ADL 7-15

3 RVX - Extensive Services criteria

+ RV Criteria – ADL 16-18

4 RVL - Extensive Services criteria

+ RV Criteria – ADL 7-15

5 RHX – Extensive Services criteria +

Rehab High Criteria - ADL 13-18

6 RHL- Extensive Services criteria

+ Rehab High Criteria - ADL 7-12

7 RMX - Extensive Services criteria + RM

Criteria – ADL 15-18

8 RML- Extensive Services criteria

+ RM Criteria – ADL 7-15

9 RLX – Extensive Services criteria + RL

Criteria – ADL 7-18

10 RUC – Special Rehab Ultra High – ADL

16-18

11 RUB – Special Rehab Ultra High – ADL

9-15

12 RUA – Special Rehab Ultra High – ADL

1-8

13 RVC – Special Rehab Very High – ADL

16-18

14 RVB – Special Rehab Very High – ADL 9-

15 RVA – Special Rehab Very High – ADL 1-

16 RHC – Special Rehab High – ADL 13-18

17 RHB – Special Rehab High – ADL 8-12

18 RHA – Special Rehab High – ADL 1-7

19 RMC – Special Rehab Medium – ADL 15-

20 RMB – Special Rehab Medium – ADL 8-

21 RMA – Special Rehab Medium – ADL 4-7

22 RLB – Special Rehab Low – ADL 15-18

23 RLA – Special Rehab Low – ADL 1-3

24 ES3 – Extensive Services – ADL 2-16

25 ES2 – Extensive Services – ADL 2-16

26 ES1 – Extensive Services – ADL 2-16

27 HE2 – Special Care High – ADL 15-16

28 HE1 – Special Care High – ADL 15-16

29 HD2 – Special Care High – ADL 11-14

30 HD1 – Special Care High – ADL 11-14

31 HC2 – Special Care High – ADL

6-10

32 HC1 – Special Care High – ADL

33 HB2 – Special Care High – ADL

2-5

34 HB1 – Special Care High – ADL

35 LE2 – Special Care Low – ADL

15-16

36 LE1 – Special Care Low – ADL

37 LD2 – Special Care Low – ADL

11-14

38 LD1 – Special Care Low – ADL

39 LC2 – Special Care Low – ADL

40 LC1 – Special Care Low – ADL

41 LB2 – Special Care Low – ADL

42 LB1 – Special Care Low – ADL

43 CE2 – Clinically Complex – ADL 15-16

44 CE1 – Clinically Complex – ADL 15-16

45 CD2 – Clinically Complex – ADL 11-14

46 CD1 – Clinically Complex – ADL 11-14

47 CC2 – Clinically Complex – ADL 6-10

48 CC1 – Clinically Complex – ADL 6-10

49 CB2 – Clinically Complex – ADL 2-5

50 CB1 – Clinically Complex – ADL 2-5

51 CA2 – Clinically Complex – ADL 0-1

52 CA1 – Clinically Complex – ADL 0-1

53 BB2 – Behavior Symptoms – ADL 2-5

54 BB1 – Behavior Symptoms – ADL 2-5

55 BA2 – Behavior Symptoms – ADL 0-1

56 BA1 – Behavior Symptoms – ADL 0-1

57 PE2 – Physical Function Reduced – ADL

58 PE1 – Physical Function Reduced – ADL

59 PD2 – Physical Function Reduced – ADL

60 PD1 – Physical Function Reduced – ADL

61 PC2 – Physical Function Reduced – ADL

62 PC1 – Physical Function Reduced – ADL

63 PB2 – Physical Function Reduced – ADL

64 PB1 – Physical Function Reduced – ADL

65 PA2 – Physical Function Reduced – ADL

0-1

66 PA1 – Physical Function Reduced – ADL

0-1

B.7 ACCEPTABLE SAFETY AND SANITATION PRACTICES

Acceptable safety and sanitation practices shall be observed throughout the facility. The building shall conform to the standards of the Life Safety Code (National Fire Protection Association Standard #101) in effect on the date of contract award.

B.8 MEDICARE/MEDICAID STANDARDS

The contractor is required to follow Medicare/Medicaid standards for all VA placements, except Life

Safety. Medicare and Medicaid clinical and program standards are found in 42 CFR 483

B.9 INVOICES

Invoices shall be submitted promptly to the authorizing facility by the 15th calendar day following the end of the month in which services were rendered. All invoices must include the full name and address of the nursing home and shall reflect the patient's name, social security number, number of days billed, level of care category, and per diem rate. Failure to include this information may result in delayed payments.

B.10 AUTHORIZATIONS

Authorizations for nursing home care will be accomplished on VA Form 10-7078, Authorization and

Invoice for Medical and Hospital Services. Each authorization validity period will be from the…