36C24621R0037.docx

36C24621R0037

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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

36C24621R0037 12-21-2020 Wyona Davis, Contracting Specialist 757-728-7013 12-20-2021 Department of Veterans Affairs Network Contracting Office 6 100 Emancipation Drive Hampton VA 23667 X N 624120 $12 million X N/A X Department of Veterans Affairs Fayetteville VAMC 2300 Ramsey Street Fayetteville NC 28301-3856 Department of Veterans Affairs Network Contracting Office 6 100 Emancipation Drive Hampton VA 23667

Department of Veterans Affairs Fayetteville VAMC ATTN: Keninthe Davis 2300 Ramsey Street Fayetteville NC 28301-3856 28301-3856 As a result of this Request for Proposals (RFP), the government anticipates awarding multiple Indefinite Delivery Indefinite Quantity Contracts (IDIQ) under authority 38 U.S.C. 1720 for Adult Day Health Care services provided to eligible veterans assigned to the Fayetteville Veterans Affairs Medical Center in North Carolina.

Various surrounding counties in close proximity are to be considered.

X X X one(1) Mario L. Santiago Contracting Officer Table of Contents

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. CONTRACTOR:

b. GOVERNMENT: Contracting Officer 36C246 Mario L. Santiago 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.

Department of Veterans Affairs Fayetteville VAMC ATTN: Keninthe Davis 2300 Ramsey Street Fayetteville NC 28301-3856 ACKNOWLEDGMENT OF AMENDMENTS: The offeror acknowledges receipt of amendments to the Solicitation numbered and dated as follows:

5. All Adult Day Health Care (ADHC) Facilities must invoice using the CMS 1450 (UB-04) or HCFA 1500 form. These forms must be original documents and can be downloaded free from the following site.

https://www.cms.gov/medicare/cms-forms/cms-forms/cms-forms-list.html

6. All claims and supporting documentation should be mailed to the locations, or faxed to the number and to the attention of the individuals listed below:

Fayetteville VA Medical Center Geriatrics & Extended Care Service (11G) Community Based Programs Coordinator Attention: Keninthe Davis 2300 Ramsey Street Fayetteville, NC 28301-3856 Phone: 910-488-2120 Extension 7312 Fax: 910-482-5163

7. Claim Filing Instructions for Preauthorized Care. Claims submitted to VA for payment consideration must include a completed original CMS 1500 and/or CMS1450 (UB-04) billing forms to 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. Per Diem Rate

* The daily/weekly/monthly Attendance Log (sign in/sign out sheets) signed by the Veteran/Next of Kin/appropriate staff must be attached to the invoice. Failure to include this information may result in delayed payments.

8. TRANSPORTATION

1. Transportation rates are authorized by Title 38 U.S.C. 111A through the end of each year. If this law is rescinded or otherwise amended by Congress, these services will be removed from this Indefinite Delivery Indefinite Quantity (IDIQ) contract through modification to this IDIQ and will be effective at the beginning of the specified fiscal year (i.e., 10/01/2021).

1. The Contractor is responsible to ensure any transportation services provided pursuant to the IDIQ complies with all pertinent provisions of Federal, State and local statues, rules and regulations.

1. Transportation is defined as either a one way or round trip to/from the Veteran’s residence and the ADHC facility. The VA reserves the right to return a claim with a request for additional information. Preauthorized claims must be submitted within 6 (six) years of treatment date.

9. AUTHORIZATIONS

Authorizations for adult day health 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 initial effective date to disposition. Any extension to the original authorization validity period, regardless of the number of days, requires a new VA Form 10-7078.

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

B.2 BASIC ORDERING AGREEMENT TERMS AND CONDITIONS OF THIS AGREEMENT

This is an Indefinite Quantity Indefinite Delivery (IDIQ) contract for the period from the effective date to the date of contract expiration, in accordance with FAR 16.7. A contract is formed, in accordance with the terms and conditions of this agreement, when VA agrees to refer a patient to the Community Adult Day Health Care facility (CADHC) and the CADHC agrees to accept the patient. Upon acceptance by the contractor of beneficiaries of Department of Veterans Affairs (VA), all terms and conditions of this agreement shall apply during such time as a VA patient attends that CADHC at the expense of VA. Upon acceptance of a VA patient by the CADHC, if and when requested by the Contracting Officer or authorized representative, the contractor shall furnish all services herein described, at the per diem rates for the services specified on the authorization for that veteran. VA schedule descriptions are defined in Section D of this agreement.

B.3 RATE DETERMINATION

The per diem rate is established by North Carolina Department of Medical Assistance Services plus a fair market amount (percentage) to cover the cost of supplies, services, and equipment above that the provider under Medicaid established based on the local state Medicaid agency (SMA). Rates established after the effective date of this contract will constitute a modification to the contract, which normally coincide with the start of the state fiscal year (SFY).

The VA will use these published rates to determine rate increases, if any are awarded based on the economic price adjustment clause and establish the base year contract rate.

B.4 PRICE SCHEDULE

CODE

Adult Day Care Center Base Year 2021- 1st Option 2022- 2nd Option 2023-

based on Gov rate

TBD -

based on Gov rate

TBD -

based on Gov rate

TBD -

based on Gov rate

TBD -

based on Gov rate

B.5 PERFORMANCE WORK STATEMENT (PWS)

COMMUNITY ADULT DAY HEALTHCARE SERVICES (CADHC)

FOR THE

FAYETTEVILLE VA COASTAL HEALTH CARE SYSTEM

Fayetteville, North Carolina

1.0. Description: Under the authority of Public Law 104-262 and 38 USC 1720B, the contractor agrees to provide Community Contract Adult Day Health Care (CADHC) in accordance with the terms and conditions stated herein, and to furnish the Fayetteville Department of Veterans Affairs Medical Center, the services defined in this Performance Work Statement (PWS) at the prices specified in the Price/Cost Schedule of this solicitation. The Government intends to award multiple indefinite delivery/indefinite quantity (IDIQ) contracts as a result of this solicitation. The period of performance is to commence on the effective date of the contract. This contract has four (4) one-year options, to be executed at the sole discretion of the Government, each with an additional 6 (six) month extension also to be executed at the Government’s discretion.

2.0. SERVICES: 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 Contract Adult Day Health Care (CADHC) and the CADHC 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 CADHC at the expense of the VA.

2.1. The Contractor shall provide all necessary personnel, equipment, and supplies associated with the full range of CADHC services in performing the requirements of this contract within the terms, conditions, and provisions of this contract.

2.2. This contract/agreement is entered under the authority in 38 CFR 1720B.

2.6. Upon acceptance of a VA patient by the CADHC, when requested by the Contracting Officer or authorized representative, the contractor shall furnish all supplies and services herein described, at the rates specified in the pricing schedule. VA is obligated only to the extent authorized of placements of patients are made under this contract.

2.7. Contractors must have and maintain, for the life of the contract, current State of North Carolina Licensure and State of North Carolina Medicaid Certification to meet the requirements of this contract.

3.0. REQUIREMENTS:

3.1. Community Contract Adult Day Health Care will be furnished to beneficiaries for whom such care is specifically authorized by the Department of Veterans Affairs Medical Center. It is understood that the type of patient to be cared for under this contract will receive these services as a substitute for institutionalization. The purpose of providing CADHC is:

a. to enable functionally impaired individuals to reside in supportive home environments rather than in nursing home care facilities;

b. to facilitate the return of older veterans to their home and coordinate long term care there by reducing readmissions to hospitals and nursing homes;

c. to maintain the elder veteran at the highest level of functioning possible;

d. to improve the quality of life for the participants; and

e. to provide support for the family and other caregivers of elder veterans.

CADHC FACILITY GUIDELINES:

3.2. The Contractor shall provide medical services, nursing, social work services, assistance with activities of daily living, activity therapy, case management, nutrition service including meals and snacks, restorative care, and transportation. Care shall be provided, in a protective setting during part of the day but less than 24-hours, through contract arrangements with facilities licensed or certified or state approved by and in good standing with the State’s Department of Human Resources and other states agencies as appropriate as a Contract Adult Day Health Care (Medical/Dementia) (CADHC) facilities.

Unless specifically excluded in this contract, the per diem rate established will include the services listed in the paragraph above and will also include all services or supplies normally provided other patients by the facility without extra charge. It is agreed that the VA may readily have access to all medical records concerning the Veteran’s care in the CADHC Program.

3.3. The Contractor shall provide therapeutically focused care during daytime hours with the goal of improving the health and functional status of frail, elderly Veterans with disabling physical and mental disorders who are attempting to remain in the community and avoid institutionalization. The CADHC shall motivate and educate patients to achieve and maintain independence in activities of daily living to the maximum extent possible. Every effort shall be made to keep patients ambulatory and to achieve an optimal level of self-care.

3.3.1 The Government may evaluate the quality of professional and administrative services provided but retains no control over the medical/professional aspects of services rendered (e.g. professional judgments, diagnosis for specific medical treatment) in accordance with FAR 37.401(b).

3.4. The Contractor shall not maintain nor provide dual or segregated patient facilities which are segregated based on race, creed, color or national origin. The Contractor shall neither require such segregated use by written or oral policies nor tolerate such use by local custom. The term "facilities" shall include but not be limited to rooms, wards, sections, eating areas, drinking fountains, entrances, and other like areas.

3.5. The CADHC shall accept referral of and shall provide all services specified in this contract for any person determined eligible by the VA Chief Medical Director or his/her designee, regardless of the race, color, religion, sex or national origin of the person for whom such services are ordered. In addition, the CADHC Program warrants that subcontracting will not be resorted to as a means of circumventing this provision.

3.6. All medical records concerning the veteran's care in the CADHC will be readily accessible to the VA. Upon discharge or death of the patient, medical records will be retained by the CADHC contractor for a period of at least three 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 that includes at a minimum the following:

a. Admission record, including assessment and diagnosis

b. Physician orders;

c. Treatment plan;

d. Progress notes;

e. Periodic evaluations;

f. Discharge Summaries; and

g. Other usual and customary information pertinent to patient care

3.7. The beneficiary will be provided to the CADHC at the expense of VA for a period not in excess of that stated in the referral/Authorization form, unless an extension of the authorization is provided in writing by the placing VA facility.

3.8. If the VA Medical Center and the CADHC Provider agree that the VA shall provide services under 38 CFR 17.51(f), the agreement will be incorporated into the contract and either the per diem rate will be re-established, or direct payment made to the United States to reflect the cost of VA's contribution.

3.9. The Contractor shall submit a properly executed HCFA or UB-04 claim form monthly for each VA funded participant to VA Fee Services for the purpose of claims processing.

3.10. Absences of the patient from the CADHC Program will not be reimbursable. The Contractor’s ADHC Program will meet the VA standards for ADHC as promulgated in 38 CFR 17.51(c) through 17.51(e).

3.11. Payments made by VA under this contract constitute the total cost of Adult Day Health Care. No additional charges will be billed to Medicare Part B, the beneficiary or his/her family, either by the Adult Day Health Care facility or any third part 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 contractor will not solicit contributions, donations, or gifts from patients or family members.

3.12. The Contract Adult Day Health Care Program Coordinator/Social Worker (CADHC Coordinator/Social Worker or designee) will coordinate annual inspections of all CADHC facilities as outlined in VA regulations.

4.0. COMMUNITY ADULT DAY HEALTH CARE (CADHC) SERVICES:

4.1. Activities: Therapeutic programming includes recreational services and leisure activities to meet the physical and social needs of the participants and is an integral part of each client’s treatment program. The intent of these services is to provide a method for participants to use their time meaningfully during each session. These services and activities may include, but are not limited to, arts and crafts, music, TV and radio stimulation, physical exercise, books and magazines, games, field trips, and other appropriate activities.

4.2. Nutrition: The Contractor shall provide two (2) snacks, one (1) in the morning and one (1) in the afternoon, and one (1) hot lunch daily.

4.3. Special Diets/Feeding Needs: The Contractor shall provide special diets, enteral feeding, and cutting of food and/or hand feeding when required under the supervision of a registered dietitian.

4.4. Personal Care Assistance: The Contractor shall provide reminders and/or directions for continence care and stand-by assistance/supervision with personal care such as toileting, dressing, and bathing when needed. Bathing will be authorized and paid on a per bath or shower basis. Veterans usually receive no more than three baths or showers per week.

4.5. Incontinence Care: The Contractor shall provide full assistance in toileting, catheter care, disposable undergarments, and changing/laundering of soiled clothing, as required.

4.6. Supervision: The Contractor shall provide a high degree of safety supervision for wandering/ambulating, and/or behavioral supervision for combativeness, agitation, aggression, withdrawal, etc.

4.7. Physical Transferring: The Contractor shall provide physical assistance/ human help or lifting for transferring in order to accomplish personal care, transportation, safety, incontinence care, etc.

5.0. CLINICAL SERVICES:

5.1. Nursing Services: The Contractor shall provide skilled nursing services to include medication administration (oral and injectable), necessary nursing treatments, and supervision of prescribed therapies (Oxygen, range of motion, etc.) In addition, the CADHC program will manage the patient plan of care while providing the patient’s social and health needs. The CADHC must meet State Requirements for nursing services. There shall be at least one licensed registered nurse or licensed vocational nurse on duty during the main hours of operation to provide ongoing nursing assessments and skilled nursing care, as needed. There shall be sufficient nurses and/or Nursing Assistants (NA) to provide supportive nursing care and assistance in daily program activities (see 11.0 PERSONNEL POLICY below). At a minimum, the facility must employ a full time licensed vocational nurse under the supervision of a registered nurse consultant. The registered nurse consultant must provide on-site consultation four hours per week. The ratio of direct service staff to clients shall be at least one staff person for every six patients during provision of all covered services except during facility provided transportation. Staff counted in the veteran to staff ratio are only those who spend at least 70% of their time in direct care services.

5.2. Medical Services: A VA physician shall provide primary medical services. There shall be a Physician Medical Director to review the CADHC facility’s clinical policies and procedures annually.

5.3. Social Services: Each Veteran referred for contracted services will have a VA Social Worker assigned for oversight requirements. General social services should be available as an integral part of the program to provide social assessments and appropriate counseling to participants and their caregivers.

5.4. Rehabilitation Services: Maintenance therapies shall be provided as part of the ongoing therapeutic program. All restorative therapies must be provided under the supervision of a qualified physical and/or occupational therapist on a consultative basis when indicated and or requested by the VA.

5.5. Nutrition Services: Nutrition services shall be provided, with the consultation of a Registered Dietician as necessary, to include counseling, regular meals, and special diets.

5.6. Recreation Services: As an integral part of the individual treatment program, recreational services shall be provided to meet the physical and social needs of the participants.

6.0. TRANSPORTATION:

6.1. CADHC's primary role is in facilitating Veterans’ maximum use of community transportation systems, identifying systems, aiding in the application process, etc. Such systems may include:

a. Area "Agency on Aging" supported transportation;

b. Caregivers;

c. Regional transit;

d. Local handicapped transportation resources;

e. Veteran Service Organization vehicles; and

f. Volunteer transportation systems, etc.

6.2. When there is a lack of adequate community transportation systems, coordination of local Disabled American Veteran (DAV) transportation services may be sought.

6.3. If authorized by the VA, and at the option of the beneficiary, the Contractor may directly provide transportation (in properly equipped, maintained, licensed and insured vehicle and operated by a licensed driver) or utilize appropriate public transportation. Services provided will be paid by the Contractor and will be invoiced to the VA not to exceed the VA Approved Rate for Transportation as specified in the Price Schedule. The following VA Approved Rates will apply:

6.3.1. Transportation provided to the beneficiary

6.3.2. Transportation provided to the beneficiary to and from a location radius of 40 miles from the CADHC facility will be paid at the rate specified in the Price Schedule line items.

Round Trip – Shall not exceed 80 miles.

One-Way Trip – Shall not exceed 40 miles.

‘Round Trip’ is defined as; pick-up and return of a veteran from their location, delivered to the CADHC facility and returning the veteran to their desired location; within the 40-mile radius.

‘One-Way Trip’ is defined as; pick-up of a Veteran from their location and delivered to the CADHC or Returning a veteran from the CADHC facility to their desired location; within the 40-mile radius.

Miles are calculated as:

Miles traveled from the CADHC center to a veteran’s pick-up location.

Miles traveled from the CADHC center to a veteran’s drop off location.

6.4. At the option of the beneficiary, and at no additional cost, the Contractor is responsible for assisting the beneficiary in arranging transportation from and return to the beneficiary’s place of residence. Transportation may be provided via privately operated vehicle (POV) by a friend or relative of the beneficiary, or by an activity providing veteran transportation as a public service. If any of these forms of transportation are provided the Contractor will not be responsible or liable for the transportation and will not be compensated for the services provided.

6.5. The Contractor will not bill the beneficiary, his/her family, or any third party, for any transportation provided under this agreement.

7.0. AUTHORIZATIONS:

7.1. This contract is established for providing VA beneficiaries community CADHC services in a Contractor furnished facility. The primary user of this agreement will be the Fayetteville VA Coastal Health Care System. Other VHA activities may utilize this agreement and are authorized to place eligible beneficiaries. It is the Contractor’s responsibility to verify the authority of any individual attempting to make a placement and to promptly notify the VA facility’s Contracting Officer’s Representative (COR) of any placement made by a different VHA activity.

2300 Ramsey Street Fayetteville, NC 28301

7.2. VA FORM 10-7078. Authorizations for CADHC services will be accomplished on a VA Form 10-7078, Authorization and Invoice for Medical and Hospital Services. Each authorization validity period will be from the initial effective date to disposition. Any extension to the original authorization validity period, regardless of the number of days, requires a new or updated VA Form 10-7078.

7.3. VA INDIVIDUALS AUTHORIZED TO PLACE BENEFICIARIES. All authorizations must be initiated by and confirmed by the authorized Contracting Officer’s Representative (COR) of which a copy of the authorization will be provided to the Contractor.

7.4. Placements will be made in contract facilities based on availability of facilities and the desires of the veterans and their respective families. It is not possible to determine actual usage of any particular contract facility.

7.5. VAMC referrals will be faxed to CADHC facilities and will include the following: A provider referral, Adult Day Health Care Medical Report, a diet order or nutrition assessment, current tuberculin test or chest x-ray/PPD/T-Spot and other pertinent information as determined by the CADHC Team prior to Veteran’s arrival.

7.6 The CADHC Registered Nurse (RN) and SW will be assigned the responsibility of making rotational, onsite follow-up visits at least quarterly and PRN to ensure that adequate and safe care is being provided, assess the need for continuation of CADHC and monitor occurrences of falls, other injuries, medication errors, restraint use, weight loss greater than 5%, dehydration, and loss of ADL function. Visits will be documented in the VAMC patients’ electronic record by VA RN and/or SW.

8.0. SPECIAL TERMS AND CONDITIONS:

8.1. Referral and Acceptance of Clients: It is understood that veterans to be cared for under this contract, as referred by the Associate Chief of Staff, Geriatrics and Extended Care Product Line, or his/her designee, shall receive the CADHC services as a substitute for nursing home care. The purpose of providing CADHC services is to:

a. Facilitate the ability of impaired veterans to remain in their home and coordinate long-term care, thereby reducing readmission to hospitals and nursing homes;

b. Maintain the impaired veteran at the highest level of functioning;

c. Improve the quality of life for the participants among their peers; and

d. Provide support for the family and other caregivers of older veterans.

8.2. Authorization For Extension of Services: A VA beneficiary may not be provided CADHC services at the expense of the Fayetteville VA Coastal Health Care System for a period in excess of that stated in the treatment plan received from the Fayetteville VA Medical Center (VAMC), unless an extension of the authorization is provided, in writing, by the Community Care Program Manager, or his/her designee.

8.3. Changes: Changes to this contract may be made only by written modification to this contract. The modification shall be prepared by the VA Contracting Officer and, prior to becoming effective, approved and signed by the Contractor.

9.0. CONTRACTOR REQUIREMENTS:

9.1. The Contractor shall appoint a Program Manager at each Community Adult Day Health Care center covered by this contract) who shall be the Contractor’s authorized representative for technical and administrative performance of all services required at that CADHC. Contractors are expected to accept or reject veterans within 24-hour of referral. Once the patient is accepted for placement, the patient will be admitted to the adult day care on the next business day or at the patient’s convenience not to exceed one week from referral. If this time frame is exceeded the CADHC will notify the Program Coordinator who reports to the Community Care Program Manager.

9.2. All clinical concerns regarding this contract will be forwarded to the Program Coordinator who reports to the Community Care Program Manager.

9.3. Full attention shall be given to motivating and educating patients to achieve and maintain independence in activities of daily living. Every effort shall be made to keep patients ambulatory and to achieve an optimal level of self-care.

9.3.1 The Contractor shall cooperate with VA Quality Improvement activities. The VA shall have access to the Contractor’s medical records to the extent permitted by State Laws. The VA allows open practitioner-patients communications regarding appropriate treatment alternatives without penalizing the contractor for discussing medically necessary or appropriate care for the patient.

9.4. Patients who require more than the level of care safe for CADHC will not be admitted or retained. The CADHC staff will notify the VA for direction.

9.5. The Veteran will be discharged when the Veteran is no longer able to participate and/or benefit from CADHC services, has achieved the expected outcomes or treatment goals, develops needs beyond the capability of the program or demonstrates chronic non-adherence that results in serious health or safety concerns or is otherwise unable to tolerate or be managed in a group setting.

9.6. The CADHC shall provide all services specified herein for any VA patient, regardless of the race, color, religion, sex, national origin or medical condition of the person for whom such services are ordered. In addition, the CADHC warrants that subcontracting will not be resorted to as a means of circumventing this provision.

9.7. The CADHC shall allow reasonable visitation rights to family and to other persons who have a care-giving or significant relationship to the patient while the patient is attending CADHC.

9.8. It is agreed that duly authorized representatives of VA will provide follow-up visits to veterans placed on contract to ascertain continuity of care and to assist in the veteran’s transition back to the community. It is understood that these visits do not substitute for, nor relieve the adult day care in any way of the responsibility for the daily care and medical treatment of the veteran.

9.9. The beneficiary will be provided adult day care at the VA’s expense for a period not to exceed that stated in the treatment plan received from VA on admission.

9.10. Contractors providing care will:

a. Admit patients to CADHC processing all required paperwork;

b. Utilize the nursing process in assessing, planning and implementing and evaluating patient care;

c. Manage the adult day healthcare plan for the veteran assuring that such care meets or exceeds State Licensing requirements;

d. The Contractor will coordinate the adult day health care, supervise its own staff and evaluate the care and services provided to each veteran on contract;

e. The Contractor will assure that adequate staffing is available for the provision of care to meet the needs of the veterans;

f. The Contractor assures that the discharge plan is developed using appropriate resources to meet the veterans’ needs; and

g. Required Documentation - The following reports are required for the duration of the contract:

a. Telephone contact, with written notification to follow, will be made regarding any veteran on contract who experiences a sentinel event, death, major change in condition or reports abuse.

b. Telephone contact will be made to the Program Coordinator for Community Adult Day Health Care or the Administrative Officer of the Day during non-business hours.

9.11 Contractors to the Department of Veteran Affairs may be unintentionally exposed to sensitive information. Information may be overheard, seen on documents or electronic devices, or observed that could potentially violate the privacy and confidentiality of our Veterans, employees, volunteers, and their families. Regulations such as, but not limited to the Health Insurance Portability and Accountability Act of 1996 (HIPAA), Freedom of Information Act (FOIA), and Privacy Act of 1974 have been enacted to protect sensitive information from being improperly disclosed. Information should not be divulged or released to anyone unless specifically authorized by this contract or its’ attached documents in accordance with the contracted services. Failure to comply with applicable statutes and regulation can result in the termination of this contract and civil and criminal penalties, including fines and imprisonment. All suspected or actual breeches of privacy and confidentiality should be reported immediately to the Contracting Officer, Contracting Officer’s Representative (COR) or the Facility Privacy Officer.

10.0 QUALIFICATIONS:

10.1. Accreditation: The Contractor shall be licensed as an Adult Day Health Care facility by the state of North Carolina.

10.2. Compliance: The Contractor’s CADHC facility shall meet all Federal, State, and local laws, regulations, and codes pertaining to health and safety such as those regulating:

a. Construction, maintenance, and equipment;

b. Sanitation and waste management;

c. Buying, dispensing, safeguarding, administering, and disposing of medications and controlled substances; and

d. Also, it is understood that the facility shall meet the requirements of Public Law 100-336, 42 USC 12101-12213, Americans with Disabilities Act pertaining to handicapped accessibility.

10.3. VA Standards: The Contractor’s CADHC facility shall meet the VA standards for Adult Day Health Care (CADHC) Services as promulgated in 38 CFR Part 17.51c through 17.51e.

10.4. License: The Contractor’s CADHC facility shall be licensed to operate as such in compliance with the State of North Carolina. (Medicaid Waiver Program)

10.5. Liability: See VAAR Clause 852.237-7, Indemnification and Medical Liability Insurance.

10.6. Personnel: Personnel employed by the Contractor to perform the CADHC services covered by this contract shall be licensed and/or certified in a State, Territory, or Commonwealth of the United States or the District of Columbia in accordance with the State of North Carolina and all applicable Federal laws and regulations. Personnel must meet the minimum training and experience qualifications for position employed in according to North Carolina State rules.

10.7. Fire Laws: The Contractor’s facility shall conform to the standards of the current National Fire Protection Association (NFPA) Life Safety Code #101 and shall provide sufficient staff to assist patients in the event of fire or another emergency. The Contractor shall certify that their CADHC facility follows all applicable fire laws and that there are no recommendations of fire officials that have not been resolved.

11.0. PERSONNEL POLICY:

11.1. Responsibility: The Contractor shall be responsible for protecting the personnel furnishing CADHC services under this contract and, thus, shall provide the following to carry out this responsibility:

a. Worker’s Compensation;

b. Professional Liability Insurance;

c. Health Examinations;

d. Withholding Income Tax; and

e. Social Security Payments.

11.2. Non-VA Employees: The parties agree that such personnel shall not be considered VA employees for any purpose and shall be considered employees of the Contractor.

11.3. Staffing Requirements: The facility must observe the following staffing requirements:

11.3.1. One licensed registered nurse or licensed vocational nurse must be working on site during the main hours of operation to provide ongoing nursing assessments and skilled nursing care as needed. At a minimum, the facility must employ a full time licensed vocational nurse under the supervision of a registered nurse consultant. The registered nurse consultant must provide on-site consultation four hours per week.

11.3.2. There shall be enough nurses and/or nursing assistants to provide supportive nursing care and assistance in daily program activities. The ratio of direct service staff to clients shall be at least one staff person for every six patients during provision of all covered services except during facility provided transportation.

11.3.3. The facility must employ a Director who works full time, a minimum of 32 hour per week with emergency availability, performing duties related to the provision of adult day care service.

11.3.4. The facility must employ an Activities Director full time, a minimum of 32 hours per week, responsible for planning and directing the daily program activities including physical fitness exercises and other recreational activities.

11.3.5. The contracting nutrition provider must receive consultation from a dietician. The dietitian consultant plans and/or reviews menus and approves snack and luncheon menus.

11.4. Points of Contact (POC): The CADHC agency shall provide a Point of Contact (POC) who shall be responsible for the performance of the work under this agreement. The POC shall have full authority to act for the CADHC agency on all matters relating to the daily operation of this agreement. The POC must be a health care provider performing in accordance with the terms and conditions of this agreement. An alternate may be designated, but the CADHC agency shall identify, in writing, those times when the alternate shall act as the POC. The CADHC agency shall identify the POC and alternate in writing to the Fayetteville VAMC COR at the time submission of offer and confirmed upon award of contract and upon the extension of each option period. The CADHC agency shall give written notification to the COR of those times when the alternate will act as the POC. In case of EMERGENCY, the POC must be available by telephone at all times (24 hours/7 days a week), Sunday through Saturday, including Federal holidays.

12.0. PATIENT RECORDS/RECORD KEEPING SYSTEM:

12.1. Compliance: The Contractor shall maintain a record on each client to include a treatment plan, initial and periodic reevaluations, progress notes, and other usual/customary information included in client records according to state standards.

12.2. Access to Medical Records: All medical and administrative records concerning the patient’s care in the CADHC program will be readily accessible to the Department of Veterans Affairs. Upon discharge or death of the patient, the CADHC program shall retain medical and administrative records on all VA beneficiaries for a period of at least three (3) years following termination of care. Patient records will be maintained in conformance with the latest Privacy Act, and HIPAA regulations. A medical record shall be maintained for each patient and at a minimum will include:

a. Admission identification record;

b. Nursing assessment and treatment plan;

c. Physician orders as required by state licensing requirements;

d. Progress notes from nursing, dietary, and activity disciplines of patient response to CADHC services; and

e. Documentation whether or not individual patient has executed an advance directive.

12.3. Reports: The CADHC program shall submit a monthly report on the attendance, medical, functional, and psychosocial status of the beneficiaries receiving care under this contract. The report shall be sent to the Program Coordinator who reports to the Community Care Program Manager.

12.4 Establishment/Maintenance: The Chief, Extended Care Service Line, or his/her designee, shall establish and maintain a record-keeping system that will contain the date(s) when CADHC services were provided to VA beneficiaries and confirmation from the Contractor and caregivers of the dates CADHC services were performed.

12.5 Certification of Invoices: VAMC’s record-keeping system shall be the basis of determination that services were received by the Government in the certification of invoices for payment. Absences of the patient from the CADHC program will not be reimbursed.

13.0. CONTRACTING WITH PARTIES LISTED ON THE OIG LIST OF EXCLUDED INDIVIDUALS/ENTITIES:

13.1. In accordance with The Health Insurance Portability and Accountability Act (HIPAA) and the Balanced Budget Act (BBA) of 1977, the Office of Inspector General has established a list of parties and entities excluded from Federal health care programs. Specifically, the listed parties and entities may not receive Federal Health Care program payments due to fraud and/or abuse of the Medicare and Medicaid programs.

13.2. Therefore, all offerors shall review the OIG List of Excluded Individuals/Entities on the OIG web site at www.hhs.gov/oig to ensure that the proposed candidate(s) and/or firm(s) are not listed. Offerors should note that any excluded individual or entity that submits a claim for reimbursement to a Federal health care program, or causes such a claim to be submitted, may be subject to a Civil Monetary Penalty (CMP) of $10,000 for each item or service furnished during a period that the person or entity was excluded and may also be subject to treble damages for the amount claimed for each item or service. CMPs may also be imposed against health care providers and entities that employ or enter into contracts with excluded individuals or entities to provide items or services to Federal program beneficiaries.

13.3. By signing the offer/bid, the Contractor certifies that he/she has reviewed the OIG List of Excluded Individuals/Entities and that the proposed candidate(s) and/or firm are not listed as of the date the offer/bid was signed.

14.0. ADMINISTRATIVE REQUIREMENTS AND PROCEDURES:

14.1. Payment Terms and Conditions: As it is impossible to determine the exact or estimated amount which will be expended under this contract, it is understood that no obligation will be incurred by the Department of Veterans Affairs, under this contract until authorizations are issued for CADHC services for specific beneficiaries. The Fayetteville VAMC agrees to make payment on a timely basis for CADHC services rendered in accordance with such authorizations upon receipt of billings submitted by the Contractor’s CADHC facility at the completion of each month’s CADHC services. If a beneficiary is admitted to and discharged from the contractor’s CADHC program on the same calendar day payment will be made for one day. Invoices shall be submitted to the Department of Veterans Affairs facility authorizing admission of the patient.

14.2. Invoices: The Contractor shall submit monthly, by the fifteenth (15th) calendar day of each month, an invoice for services performed under the contract during the previous month. One (1) payment shall be made per month. All invoices shall include the following information:

a. Name, address, telephone number, and federal tax identification number of Contractor;

b. Invoice date;

c. Contract number or other authorizations for payment;

d. Number/dates of days billed; a daily attendance roster for each client must be submitted with billing; HCPC Code/Health Care Common Procedure Coding System, Diagnosis Code/ICD 10

e. Name and social security number of VA beneficiaries to who services were provided;

f. Unit of Service rate or Level of care category, per diem rate, total number of units attended by veteran, and total dollar amount*;

g. Invoices shall be submitted in arrears on a monthly basis; and

h. Original red copy of CMS 1450.

Failure to include this information may result in delayed payments.

14.3. Billings in Full: Invoices submitted by the Contractor to the Department of Veterans Affairs for CADHC services furnished to a VA beneficiary under the terms of this contract shall be billings in full. The Contractor shall neither bill the beneficiary, his/her insurer, nor any other third party.

15.0. DEPARTMENT OF VETERANS AFFAIRS RESPONSIBILITIES:

15.1. Inspections:

15.1.1. Inspection Team: The Department of Veterans Affairs shall have the right to inspect the Contractor’s CADHC facility/program by an authorized representative(s) designated by the Department of Veterans Affairs to determine whether acceptable standards are maintained, and that adequate care is being rendered. Prior to award and during the term of this contract, all inspections will be carried out by an interdisciplinary team consisting of a Social Worker, Registered Nurse, Dietitian, and Fire Safety Specialist.

15.1.2. Deficiencies: If deficiencies are noted during any inspection, the Contractor will be advised of the inspection team’s findings and given a reasonable time to take corrective action. Any deficiencies shall be documented, and MUST be corrected within the timeframe specified by the inspection team. The Contractor will notify the Program Coordinator when correction(s) have been made. However, if inspection deficiencies are found prior to award of the contract, the contract shall not be awarded until noted deficiencies have been eliminated/resolved.

15.1.3. Follow-Up Supervision Visits: Duly authorized representatives of the Department of Veterans Affairs shall provide follow-up supervision visits to veterans placed in the Contractor’s CADHC facility to assure the continuity of care and to assist in the patient’s transition back into the community. It is understood that these visits do not substitute nor relieve the CADHC program in any way of the responsibility for the daily care and medical treatment of the veteran.

15.1.4. Evaluation: The Department of Veterans Affairs may evaluate the quality of professional and administrative services provided but retains no control over the medical/professional aspects of services rendered (e.g., professional judgments, diagnosis for specific medical treatment) in accordance with FAR 37.401(b). Evaluation team will consist of the Program Manager and Contracting Officers Representative.

15.2. Payment: Payments made by the VA under this IDIQ constitute the total cost of CADHC services. No additional charges shall be billed to the beneficiary or his/her family. The Contractor shall not solicit contributions, donations, or gifts from patients or family members. The VA agrees to make payment on a timely basis for services rendered in accordance with the Payment provision and upon receipt of properly submitted invoices.