36C24619R0028.docx

36C24619R0028

PAGE 1 OF

1. REQUISITION NO.

2. CONTRACT NO.

3. AWARD/EFFECTIVE DATE

4. ORDER NO.

5. SOLICITATION NUMBER

6. SOLICITATION ISSUE DATE

a. NAME

b. TELEPHONE NO. (No Collect Calls)

8. OFFER DUE DATE/LOCAL

TIME

9. ISSUED BY

CODE

10. THIS ACQUISITION IS

UNRESTRICTED OR

SET ASIDE:

% FOR:

SMALL BUSINESS

HUBZONE SMALL

BUSINESS

SERVICE-DISABLED

VETERAN-OWNED

SMALL BUSINESS

WOMEN-OWNED SMALL BUSINESS

(WOSB) ELIGIBLE UNDER THE WOMEN-OWNED

SMALL BUSINESS PROGRAM

EDWOSB

8(A)

NAICS:

SIZE STANDARD:

11. DELIVERY FOR FOB DESTINA-

TION UNLESS BLOCK IS

MARKED

SEE SCHEDULE

12. DISCOUNT TERMS

13a. THIS CONTRACT IS A

RATED ORDER UNDER

DPAS (15 CFR 700)

13b. RATING

14. METHOD OF SOLICITATION

RFQ

IFB

RFP

15. DELIVER TO

CODE

16. ADMINISTERED BY

CODE

17a. CONTRACTOR/OFFEROR

CODE

FACILITY CODE

18a. PAYMENT WILL BE MADE BY

CODE

TELEPHONE NO.

DUNS:

DUNS+4:

PHONE:

FAX:

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

SEE ADDENDUM

19.

20.

21.

22.

23.

24.

ITEM NO.

SCHEDULE OF SUPPLIES/SERVICES

QUANTITY

UNIT

UNIT PRICE

AMOUNT

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

25. ACCOUNTING AND APPROPRIATION DATA

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

ARE

ARE NOT ATTACHED.

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

ARE

ARE NOT ATTACHED

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

29. AWARD OF CONTRACT: REF. ___________________________________ OFFER

COPIES TO ISSUING OFFICE. CONTRACTOR AGREES TO FURNISH AND

DATED ________________________________. YOUR OFFER ON SOLICITATION

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

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

ADDITIONAL SHEETS SUBJECT TO THE TERMS AND CONDITIONS SPECIFIED

SET FORTH HEREIN IS ACCEPTED AS TO ITEMS:

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

AUTHORIZED FOR LOCAL REPRODUCTION

(REV. 2/2012)

PREVIOUS EDITION IS NOT USABLE

Prescribed by GSA - FAR (48 CFR) 53.212

7. FOR SOLICITATION

INFORMATION CALL:

STANDARD FORM 1449

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

SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL ITEMS

36C24619R0028 4:30 pm 36C246 Department of Veterans Affairs Network Contracting Office 6 100 Emancipation Drive Hampton VA 23667 X $27.5 Million X N/A X Department of Veterans Affairs Network Contracting Office 6 100 Emancipation Drive Hampton VA 23667 36C246 Department of Veterans Affairs Network Contracting Office 6 100 Emancipation Drive Hampton VA 23667

W.G. Hefner Veterans Affairs Medical Center 1601 Brenner Avenue Salisbury, NC 28144 Attn. Jenny Wade See CONTINUATION Page Solicitation for Community Nursing Home Services FY19 See CONTINUATION Page X X 1(one) Christian A. Rosado Ramirez 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:

b. GOVERNMENT: Contracting Officer 36C246 Marchelle Peyton Department of Veterans Affairs Network Contracting Office 6 100 Emancipation Drive Hampton VA 23667

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.

Claim Submission: Submit claims and all documentation for payment by fax, to the VA facility authorizing placement and to the attention of the individual listed for that facility.

a. W.G. Bill Hefner VA Medical Center 1601 Brenner Avenue Salisbury, NC 28144 Attn: Karen Montanaro Fax: 704-639-2392

Claim Filing Instructions for Preauthorized Care. Claims submitted to VA for payment consideration must include at a minimum, the following patient and provider information:

1. Patient’s Name (including middle initial)

1. Patient’s Address (including zip code)

1. Patient’s Social Security Number

1. Provider’s Name

1. National Provider Identifier (NPI) Number

1. Provider Taxonomy Code(s), if known

1. Tax Identification Number (TIN/EIN)

1. Professional Status of Provider (MD, PA, NPA, etc.)

1. Facility Address where care was provided

1. Remit to (mailing address) where payment should be sent

1. All appropriate medical coding

1. All other health insurance information

1. Date(s) of service

1. RUGS IV Category and Rate

VA reserves the right to return a claim with a request for additional information. Preauthorized claims must be submitted within 6 years of treatment date.

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

SPECIAL CONTRACT REQUIREMENTS

Under the authority of Public Law 104-262 and 38 USC 1720, the contractor agrees to provide Health Care Resources in accordance with the terms and conditions stated herein, to furnish to and at the Department of Veterans Affairs Medical Center, the services and prices specified in the Section entitled Schedule of Supplies/Services of this contract.

2.1. SERVICES:

2.1.1. This is a Indefinite Delivery Indefinite Quantity (IDIQ) for the period of 1 (one) year plus 4-one year option periods after the effective date of the contract. A contract is formed, in accordance with the terms and conditions of this Agreement, when the Department of Veterans Affairs (VA) agrees to place a patient in the nursing home and the nursing home agrees to accept the patient. Upon acceptance by the contractor of beneficiaries of the VA, all terms and conditions of this agreement shall apply during such time as the VA patient remains in that nursing home at the expense of the VA.

2.1.2. This IDIQ is entered into under the authority in 38 CFR 1720.

2.1.3. The Contracting Officer shall review the IDIQ annually before the anniversary of its effective date and if necessary issue a modification to incorporate any statutory requirements.

2.1.4. The services specified in the Sections B.2 through B.12 may only be changed by written modification to this IDIQ.

2.1.5. Upon acceptance of a VA patient by the nursing home, if and when requested by the 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 below. VA levels of care are defined in Section E of this agreement. VA is obligated only to the extent authorized placements of patients are made under this agreement.

2.2. PERSONNEL POLICY:

2.2.1. The contractor shall be responsible for protecting the personnel furnishing services under this IDIQ. To carry out this responsibility, the contractor shall provide the following for these personnel:

· general liability

· workers compensation

· professional liability insurance

· health examinations

· income tax withholding, and

· Social security payments.

2.2.2. The parties agree that the contractor, its employees, agents and subcontractors shall not be considered VA employees for any purpose

2.3 ANCILLARY COSTS

2.5.1 Ancillary costs are pre-approved costs for supplies or services not identified as included in the all-inclusive rate or any other pre- authorized rate or schedule or payment for items or services provided under this agreement. Ancillary costs such as medications, and special equipment, may not be added to any invoice without written permission of the VA medical center placing the veteran. If permission is received, the nursing home must also submit the physician's order for the medication/supply, the dispensing log, the supplier and the cost charged by the supplier to the nursing home, and what the nursing home is charging the VA.

B.2 RATE DETERMINATION

The per diem rate is established by the current Medicaid rate for Medicaid approved nursing homes plus a fair market amount (percentage) to cover the cost of supplies, services, and equipment above that provided under Medicaid established by the local state Medicaid agency (SMA). Rates established after the effective date of this contract will constitute a modification to the contract.

VA will use Medicaid rates for room, board, and routine nursing care.

For all levels of nursing care, a percentage is added for routine ancillary services/supplies, such as drugs, nursing supplies, oxygen (occasional use), x-ray, laboratory, physician visits, and rental equipment.

Special equipment, e.g. clinitron bed, is/are not considered routine ancillary services (and may be provided by the VA).

Drug costs which comprise more than eight and one-half percent (8.5%) of the per diem rate are generally not considered routine ancillary supplies (and may be provided by the VA).

Rehabilitation therapies will be provided as a distinct level of care. Hospice Care and Dialysis are not included in the rate. VA or other payers may be used for Hospice and Dialysis, as determined by the veteran with VA approval.

B.3 ORAL 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.

B.4 PRICE SCHEDULE PER RUG IV

State Medicaid Reimbursement Rate: $

CLIN Number

RUGS IV CATEGORY DESCRIPTION AND LEVELS OF CARE

Proposed Per Diem Rate

RUX RVL RMX

RUL RHX RML

RVX RHL RLX

RUC RVC RHC RMC RLB

RUB RVB RHB RMB RLA

RUA RVA RHA RMA

ES3 ES2 ES1

HE2 HD2 HC2 HB2

HE1 HD1 HC1 HB1

LE2 LD2 LC2 LB2

LE1 LD1 LC1 LB1

CE2 CD2 CC2 CB2 CA2

CE1 CD1 CC1 CB1 CA1

BB2 BA2

BB1 BA1

PE2 PD2 PC2 PB2 PA2

PE1 PD1 PC1 PB1 PA1

(If applicable, negotiated on a case by case basis)

B.5 DESCRIPTION/SPECIFICATIONS/PERFORMANCE WORK STATEMENT

A. Overview

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

2. Services Rendered at VA Per Diem Rates. Upon acceptance of a VA patient by the Contract Nursing Home (CNH), if and when requested by the VA Contracting Officer or authorized representative, the Contractor shall furnish all supplies and services herein described, at the per diem rates for the” Levels of Care” specified in the Schedule of Items of this 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.

A. 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 services in accordance with the terms and conditions stated herein to the U.S. Department of Veterans Affairs W. G. (Bill) Hefner VAMC Health Care System (to be referred throughout out the remainder of this Performance Work Statement document as Salisbury VAMC), in Salisbury, NC 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 processing referrals of appropriate Veterans and accept veterans for which they have the capability/capacity to care. The term, “facilities,” shall include but not be limited to rooms, wards, sections, eating areas, drinking fountains, entrances, and other like areas. VA shall have the right to inspect the CNH and all appurtenances by authorized VA representative(s) to ensure that acceptable standards are maintained and that the necessary care to maintain the well-being of the patient is rendered.

B. Requirements

1. General. Nursing home facilities in the CNH Program shall ensure that care meets the health needs and promotes the maximum well-being of VA patients. Nursing home care will be furnished to ensure the total medical, nursing, and psychosocial needs of VA beneficiaries. All nursing home facilities in VA’s CNH Program must have current Center for Medicare and Medicaid Services (CMS) certification (Medicare and/or Medicaid) and a State nursing home license. The VA also uses VA-developed quality of care standards which utilize CMS and inspection criteria that are followed by the 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. 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 (MD/PA/FNP) visits will be made in accordance with current State guidelines. Laboratory, x-ray, catheter/ostomy supplies, basic wound care supplies, nutritional supplements, basic nail trimming and other basic services will be available to Veterans as needed. In addition, the care provided will include room, meals, nursing care, and other services or supplies commensurate with the VA-authorized level of care, without extra charge. The Veterans often have particular needs for Specialty Care Services and Rehab in the CNH Program which requires PRIOR APPROVAL for authorization for additional payment. Contract Nursing Home staff should follow Specialty Service/Rehab referral protocols as outline by the Salisbury VAMC CNH Program staff.

2. Duly authorized representatives of the VA will provide quality oversight visits to Veterans placed to assure continuity of care, and Salisbury VAMC CNH Program staff will assist nursing facility staff as needed in the Veterans’ transition back into the community. These visits do not substitute nor relieve the nursing facility (CNH) in any way of the responsibility for the daily care, psychosocial care, and medical treatment for the Veterans. The per diem rate(s) established in this IDC will include the cost of primary medical care, provider visits and needed consultation, drugs (up to 8.5% of the daily per diem rate), 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.

3. Termination of Services. The 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 the VA or the Veterans without additional costs to the Government.

4. 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 an updated VA Form 10-7078.

5. 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.

6. 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, some 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.

7. 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 the VA, dependent on projection for short-term or long-term residency, and adhering to the most current MDS frequency guidelines from Medicare. The applicable per diem rate will continue until the nursing facility submits a request with supporting information for a change in condition requiring a higher level of care, which could result in a higher per diem rate. Salisbury VAMC CNH Program staff will make the final determination of whether the higher per diem rate is warranted.

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 the VA.

8. Primary Medical Coverage. The assigned Contract Nursing Home (CNH) provider is the primary medical provider during the nursing home stay and is responsible for writing or approving admission and all other orders (including Psychotropic Medications) as soon as the Veteran arrives at the CNH. The CNH provider is responsible for general medical care, urgent evaluation and intervention, and appropriateness for discharge from the nursing facility. Provider visits will be according to the Center for Medicare and Medicaid Services (CMS) guidelines. The assigned CNH 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).

9. 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 will 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, functioning, and well-being. Therefore, evaluation, re-evaluation and assessments 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.

10. Emergency Care; Non-Emergent Hospital Care; Financial Responsibility; Advanced Directives. In life-threatening emergencies, nursing home staff will utilize the 911 local emergency systems as for any Resident. For non-life-threatening hospital care needs, please contact the Salisbury VAMC CNH program staff immediately. 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 until they are told otherwise. 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.

11. HIPAA Compliance. HIPAA compliance is required for all modes of communication, including e-mail. 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 (DVA). 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 Program qualifies as a medical service, so no BAA is required.

12. 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 Salisbury VAMC’s CNH program staff. The VA will monitor the professional care and administrative management of services provided to Veterans 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 Veterans. 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.

13. Corrective Action Plan (QASP Indicator #2). The CNH will cooperate with timely development of Corrective Action Plans (CAPs) related to identified deficiencies related to State, Federal or VA surveys. The CNH will develop, during 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.

14. 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% sprinkled;

c. Natural disasters. In the event of a natural disaster (flood, tornado, etc.), the CNH shall communicate all Action Plans to VA. The action plans will at a minimum identify temporary transfers of location, dates, and names of Veterans transferred; and

d. Major construction; additions; and renovations. Major construction including building additions or other renovations which may affect physical plant integrity; SHALL MEET latest NFPA 101 Life/Safety Code requirements as well as any additional VA CNH construction standards in place at the time of renovation or alteration.

15. 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.

16. 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 should be given of any Veteran death within 24-hours or immediately following 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 Salisbury VAMC CNH Program staff immediately of the death. In the event of a death of a VA beneficiary while receiving nursing home care under this IDC, the CNH will promptly notify the Salisbury VAMC which authorized admission and immediately assemble, inventory, and safeguard the patient’s personal effects. The funds, deposits, and effects left by the Veteran on 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 list 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 the VA concerning disposition. CMS regulations require retention of records for five (5) years when there is no requirement in State law.

17. Leave of Absence (LOA) – For pre-approved therapeutic passes, the Salisbury VAMC will pay a bed hold at the existing per diem rate. Therapeutic passes will be authorized by the CNH staff based on individual Veteran needs. Veterans can have 6 days of LOA per calendar year. In certain circumstances where more than 6 days of LOA in a calendar year are needed, the extra days must be pre-approved by the Chief of Geriatrics & Extended Care.

18. Bed-Hold Statement. Bed Holds, if approved by Salisbury VA CNH program staff, are used for hospitalizations, whether for Medical or Psychiatric purposes, and as long as the nursing facility is willing to re-admit the Veteran. If at any point the Veteran/family/Guardian express that they no longer want the Veteran to go back to the previous nursing facility, then the Bed Hold will end on the date that the Veteran/family/ Guardian notification was given. The VA will cover bed holds based on the following plan:

1. The Bed-Hold will begin on the date that the Veteran leaves the CNH and will be paid at the lowest per diem rate on the Rate Schedule. The full per diem will resume on the date of the Veteran’s re-admission to the CNH. After an absence of fifteen (15) consecutive calendar days, whether in a VA or in a non-Federal facility, the Veteran must be discharged from the VA Contract Nursing Home Program, and a new authorization agreement will be required. After the VA’s 15-day bed hold, the nursing home would be responsible for notifying the family if a private-pay Bed Hold is recommended for a longer period. The family would then decide whether or not to continue to hold the bed and make any payment arrangements directly with the nursing home.

1. The VA will reimburse according to the prevailing State Medicaid guidelines.

19. Reportable Events (QASP Indicator #4). The VA requires CNHs to report to the CNH Program team at the Salisbury VAMC any of the following events within 24-hours or immediately following 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 critical nursing home staff to include: Administrator; Admissions Coordinators; Director of Nursing/Director of Nursing Service; Billing Representative; Rehab Manager; and Social Worker.

4) substantiated allegations of mistreatment, neglect, abuse or misappropriation of CNH Veterans funds 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, as well as a Citation on a State survey resulting in “Immediate Jeopardy”;

9) Adverse events; and

10) Other Required Notifications- Date/time Veteran initially admitted to the CNH; when a Veteran is sent to the ED; when a Veteran is admitted to the hospital (name of hospital and admitting dx.); the date Veteran returns from the hospital; when a Veteran leaves the nursing home AMA; the date(s) the Veteran goes on pre-approved Leave of Absence; specialty service requests and rehab requests (must be pre-authorized); if Veteran appears too high-functioning for nursing home placement.

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 major 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 the Salisbury VAMC’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.

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, the 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. Suspend placement of Veterans in the CNH;

b. Increase VA monitoring via the CNH Program team until the State survey agency clears the deficiency;

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

d. Not renew the IDC; and/or

e. Terminate the IDC.

21. VA Staff Access to CNH Records (QASP Indicator #5). All medical records concerning the Veterans’ care in the CNH will be readily accessible to the VA. Upon discharge or the death of a Veteran, medical records will be retained by the CNH for a period of at least five (5) years following termination of care. Veterans’ 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 Veteran, 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 Veteran;

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

3. The Plan of Care, MDS, 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, the Veteran’s responses to treatments, changes 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 Veterans’ records 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. VA and Non-VA Care Specialty Services. The CNH staff (i.e. nursing home staff) will assume responsibility for directly arranging appointments. Non-VA Care specialty services and rehabilitation services for the veterans in the CNH Program require PRIOR APPROVAL for authorization of additional expense. Contract Nursing Home staff should follow Specialty Services/Rehab referral protocols as outlined by the Salisbury VAMC CNH program staff.

23. VA Health Care System Consultation/Resources. The Salisbury VAMC provides standard information pertaining to VA processes, along with a VA Notification Cover Sheet for each Veteran’s nursing home chart. This Cover Sheet includes important phone numbers and whom to notify for various situations/needs. Other forms outline the protocols for requesting non-emergent specialty care, rehabilitation, and transportation services.

24. Charitable Contributions. The CNH will not solicit contributions, donations, or gifts from Veterans or family members. Note: Established charitable fundraising activities of a CNH fall outside the scope of this language.

25. CNH Billing (QASP Indicator #6). Invoices for board, care and ancillary services shall be submitted promptly to the authorizing facility by the 10th calendar day following the end of the month in which services were rendered. The CNH will promptly notify the VAMC’s CNH Program staff regarding any change in Veteran status: discharge, transfer, leaving against medical advice (AMA), hospitalization, death and/or any changes in payer source and any inability to complete timely billing. All invoices must include the full name and address of the CNH and shall reflect the Veteran’s name, Social Security number, number of days billed, RUG category (ies), diagnosis code, 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: The IDC per diem rate includes 8.5% for medication expenses. Unaltered Pharmacy Invoices (photocopies are permitted) must be submitted at the same time as the Room & Board invoices, by the 10th calendar day following the end of the month in which services were rendered. No medication expenses should be added to the Room & Board invoices.

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 and should include the CNH corrected claim form .

26. Minimum Quantities; VA Payment. It is impossible to determine the exact or estimated amount which will be expended under this IDC. No obligation will be incurred by the VA under this IDC until authorizations are issued for nursing home care of specific beneficiaries. The 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.

27. VA Payments. Payments made by the 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 electronic HIPAA-compliant transactions are not required to do so. Monthly invoices for the Salisbury VAMC should therefore be faxed to the Contract Program Office.

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SECTION C - CONTRACT CLAUSES

ADDENDUM to FAR 52.212-4 CONTRACT TERMS AND CONDITIONS—COMMERCIAL ITEMS Clauses that are incorporated by reference (by Citation Number, Title, and Date), have the same force and effect as if they were given in full text. Upon request, the Contracting Officer will make their full text available.

The following clauses are incorporated into 52.212-4 as an addendum to this contract:

C.1 52.203-99 PROHIBITION ON CONTRACTING WITH ENTITIES THAT REQUIRE CERTAIN INTERNAL CONFIDENTIALITY AGREEMENTS (DEVIATION) (FEB 2015)

(a) The Contractor shall not require employees or contractors seeking to report fraud, waste, or abuse to sign or comply with internal confidentiality agreements or statements prohibiting or otherwise restricting such employees or subcontractors from lawfully reporting such waste, fraud, or abuse to a designated investigative or law enforcement representative of a Federal department or agency authorized to receive such information.

(b) The contractor shall notify employees that the prohibitions and restrictions of any internal confidentiality agreements covered by this clause are no longer in effect.

(c) The prohibition in paragraph (a) of this clause does not contravene requirements applicable to Standard Form 312, Form 4414, or any other form issued by a Federal department or agency governing the nondisclosure of classified information.

(d)(1) In accordance with section 743 of Division E, Title VII, of the Consolidated and Further Continuing Resolution Appropriations Act, 2015 (Pub. L. 113-235), use of funds appropriated (or otherwise made available) under that or any other Act may be prohibited, if the Government determines that the Contractor is not in compliance with the provisions of this clause.

(2) The Government may seek any available remedies in the event the contractor fails to comply with the provisions of this clause.

(End of Clause)

C.2 52.216-18 ORDERING (OCT 1995)

(a) Any supplies and services to be furnished under this contract shall be ordered by issuance of delivery orders or task orders by the individuals or activities designated in the Schedule. Such orders may be issued from the effective date of the contract through.

(b) All delivery orders or task orders are subject to the terms and conditions of this contract. In the event of conflict between a delivery order or task order and this contract, the contract shall control.

(c) If mailed, a delivery order or task order is considered "issued" when the Government deposits the order in the mail. Orders may be issued orally, by facsimile, or by electronic commerce methods only if authorized in the Schedule.

(End of Clause)

C.3 52.216-19 ORDER LIMITATIONS (OCT 1995)

(a) Minimum order. When the Government requires supplies or services covered by this contract in an amount of less than 1 (one) patient, the Government is not obligated to purchase, nor is the Contractor obligated to furnish, those supplies or services under the contract.

(b) Maximum order. The Contractor is not obligated to honor—

(1) Any order for a single item in excess of $ 100,000;

(2) Any order for a combination of items in excess of $ 1 million; or

(3) A series of orders from the same ordering office within 3 days that together call for quantities exceeding the limitation in paragraph (b)(1) or (2) of this section.

(c)…