36C24622R0036.pdf

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. NOV 2021)

PREVIOUS EDITION IS NOT USABLE Prescribed by GSA - FAR (48 CFR) 53.212

7. FOR SOLICITATION

INFORMATION CALL:

STANDARD FORM 1449

SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL PRODUCTS AND COMMERCIAL SERVICES

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

36C24622R0036 03-30-2022

Wyona Davis, Contracting Specialist 757-728-7013 03-29-2023

1630 EST

Department of Veterans Affairs

Network Contracting Office 6

100 Emancipation Drive

Hampton VA 23667

X

Y

623110

$30 Million

N/A

The Medical Center making the referral

See CONTINUATION Page

As a result of this Request for Proposals (RFP), the

Government anticipates awarding multiple Indefinite Delivery

Contracts (IDC) under authority 38 U.S. C. 1720 for Nursing

Home Services for eligible veterans of the Department of

Veterans Affairs in the following Counties in the State of

North Carolina: Wake, Cumberland and Cabarrus Counties.

Other counties may be considered as the need presents.

All contracts awarded from this solicitation will be Firm

Fixed Price Contracts that will consist of one base year and four, one year options.

See Addendum 52.212-1 for instructions on providing a quote.

Submit all questions and quotes to Contracting Specialist, Wyona Davis, at wyona.davis@va.gov.

Clauses and provisions not appearing in full-text are incorporated by reference.

See CONTINUATION Page

X 1

Mario L Santiago

36C24622R0036

Table of Contents

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

PRODUCTS AND COMMERCIAL SERVICES

SECTION B - CONTINUATION OF SF 1449 BLOCKS

B.1 CONTRACT ADMINISTRATION DATA

B.2 SCHEDULE OF ITEMS

B.3 ORAL MEDICATIONS

B.4 LEVELS OF CARE/RUGs IV DESCRIPTIONS

B.5 PRICE/COST SCHEDULE

B.6 DESCRIPTION/SPECIFICATIONS/PERFORMANCE WORK STATEMENT

SECTION C - CONTRACT CLAUSES

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

PRODUCTS AND COMMERCIAL SERVICES (NOV 2021)

C.2 52.252-2 CLAUSES INCORPORATED BY REFERENCE (FEB 1998)

C.3 52.216-18 ORDERING (AUG 2020)

C.4 52.216-19 ORDER LIMITATIONS (OCT 1995)

C.5 52.216-22 INDEFINITE QUANTITY (OCT 1995)

C.6 52.217-8 OPTION TO EXTEND SERVICES (NOV 1999)

C.7 52.217-9 OPTION TO EXTEND THE TERM OF THE CONTRACT (MAR 2000)

C.8 52.232-19 AVAILABILITY OF FUNDS FOR THE NEXT FISCAL YEAR (APR

1984)

C.9 VAAR 852.212-70 PROVISIONS AND CLAUSES APPLICABLE TO VA

ACQUISITION OF COMMERCIAL ITEMS (APR 2020)

C.10 VAAR 852.219-75 SUBCONTRACTING COMMITMENTS MONITORING

AND COMPLIANCE (JUL 2018)

C.11 VAAR 852.237-75 KEY PERSONNEL (OCT 2019)

C.12 VAAR 852.242-71 ADMINISTRATIVE CONTRACTING OFFICER (OCT

2020)

C.13 52.212-5 CONTRACT TERMS AND CONDITIONS REQUIRED TO

IMPLEMENT STATUTES OR EXECUTIVE ORDERS—COMMERCIAL

PRODUCTS AND COMMERCIAL SERVICES (JAN 2022)

SECTION D - CONTRACT DOCUMENTS, EXHIBITS, OR ATTACHMENTS

D.1 QUALITY ASSURANCE SURVEILLANCE PLAN (QASP)

D.2 VA PRIVACY AND INFORMATION SECUIRTY AWARENESS AND RULES

OF BEHAVIOR

D.3 WAGE DETERMINATION CABARRUS COUNTY

D.4 WAGE DETERMINATION CUMBERLAND COUNTY

D.5 WAGE DETERMINATION WAKE COUNTY

SECTION E - SOLICITATION PROVISIONS

E.1 52.212-1 INSTRUCTIONS TO OFFERORS—COMMERCIAL PRODUCTS AND

COMMERCIAL SERVICES (NOV 2021)

E.2 52.252-1 SOLICITATION PROVISIONS INCORPORATED BY REFERENCE

(FEB 1998)

E.3 52.204-24 REPRESENTATION REGARDING CERTAIN

TELECOMMUNICATIONS AND VIDEO SURVEILLANCE SERVICES OR

EQUIPMENT (NOV 2021)

E.4 52.209-7 INFORMATION REGARDING RESPONSIBILITY MATTERS (OCT

2018)

E.5 52.212-2 EVALUATION—COMMERCIAL ITEMS (NOV 2021)

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

E.7 52.233-2 SERVICE OF PROTEST (SEP 2006)

E.8 52.212-3 OFFEROR REPRESENTATIONS AND CERTIFICATIONS—

COMMERCIAL PRODUCTS AND COMMERCIAL SERVICES (NOV 2021)

SECTION B - CONTINUATION OF SF 1449 BLOCKS

B.1 CONTRACT ADMINISTRATION DATA

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

a. CONTRACTOR: _____________________________________________

Address: _____________________________________________

City/State/Zip: _____________________________________________

Facility Name: _____________________________________________

County: _____________________________________________

Point of Contact (name): _____________________________________________

Telephone Number: _____________________________________________

Fax Number: _____________________________________________

Email Address: _____________________________________________

TAX ID Number: _____________________________________________

DUNS NUMBER: _____________________________________________

b. GOVERNMENT:

Contracting Officer:

Mario L. Santiago, Branch Chief

Department of Veterans Affairs, Network Contracting Office 6

Hampton, VA 23667

Return Solicitation to:

Wyona Davis, Contracting Specialist

Department of Veterans Affairs, Network Contracting Office 6

100 Emancipation Drive

Hampton, VA 23667

Email: wyona.davis@va.gov

Phone: 757-728-7013

1.5 GENERAL INFORMATION FOR OFFERORS:

1.5.1 Registration in SAM: Federal Acquisition Regulations require that federal contractors register in the System for Award Management (SAM) located at mailto:wyona.davis@va.gov www.sam.gov. Offerors shall enter all mandatory information into the system.

Award cannot be made until the contractor has registered. Offerors are encouraged to ensure that they are registered in SAM prior to submitting their Offeror.

1.5.2 Prior to award, an exclusionary review and a thorough inspection of the nursing home facility shall be conducted by VA staff.

1.5.3 Offerors must complete and return sub-section E.8 Offeror Reps and Certs in

Section E.

1.5.4 Contractor shall maintain an Active SAM status for the duration of this contract by renewing their SAM registration annually.

1.5.5 This is an open-ended solicitation; multiple awards will be made periodically prior to March 29, 2023.

1.5.6 Instructions for Proposal Submission: Refer to Addendum, Instructions for Proposal

Submission, FAR Provision 52.212-1, Instructions to Offerors -- Commercial Items located within the provision section of this solicitation for specific instructions and documentation to be submitted with the proposal.

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

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

Management, or

[] 52.232-36, Payment by Third Party

3. INVOICES: Invoices shall be submitted in arrears:

a. Quarterly []

b. Semi-Annually []

c. Other [X - Monthly] In arrears

4. GOVERNMENT INVOICE ADDRESS: Address invoices as instructed by the VA Medical

Center making placement.

5. CONTRACT MODIFICATIONS: The Contractor is advised that only the Contracting

Officer, acting within the scope of the contract and his/her duties and responsibilities and after advice and consultation with the Contracting Officer’s Representative (COR), has the authority to make changes that will affect contract prices, quantity, quality, delivery terms and conditions, or the term of the contract. In no event shall any understanding or agreement, modification, change order, or other matters in deviation from the terms of this contract between Contractor and a person other than the Contracting Officer be effective or binding upon the Government.

All such actions must be formalized by the proper contractual document executed by the

Contracting Officer.

http://www.sam.gov/

6. SYSTEM FOR AWARD MANAGEMENT (SAM): Offeror must be registered in the System for Award Management (SAM). No contract will be entered into with an unregistered contractor.

Internet access allows registration by completing an electronic online registration application at www.sam.gov.

7. CONTRACTING OFFICER’S REPRESENTATIVE: Prior to award, the Contracting Officer will designate the Program Specialist for Primary Care to act as Contracting Officer’s

Representative (COR). All work coordination shall be made through the COR. The Contractor shall be provided a copy of the letter of delegation authorizing the COR at the commencement of the term of this agreement. No other person shall be authorized to act in such capacity unless appointed in writing by the Contracting Officer.

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

9. SECURITY LANGUAGE: The contractor retained to do work for VA under this contract requires the use and transmission of VA Sensitive Personal Information (SPI) and must follow and adhere to the security controls, enhancements, compensating controls, protocols, regulations, and VA directions as the Contracting Officer (CO) shall direct, including, but not limited to those derived from the Federal Information Security Management Act (FISMA), OMB Circular

No. A-130 and VA Handbook 6500/6500.6. The contractor must report any data breach according to the protocols and timeframes in HB 6500.

If the contractor retained to do work for VA under this contract requires access, use, etc., of VA

SPI as aforesaid, and if an actionable data breach occurs because of the contractor’s acts, omissions, or negligence in following the VA-directed security controls, enhancements, compensating controls, protocols, and/or measures, including, but not limited to the sources above, the contractor is further subject to the statutory requirement to assess liquidated damages under 38 U.S.C. §5725 in the event of a breach of Sensitive Personal Information (SPI)/

Personally Identifiable Information (PII). Said liquidated damages shall be assessed at $37.50 per affected Veteran or beneficiary. A breach in this context includes the unauthorized acquisition, access, use, or disclosure of VA SPI which compromises not only the information’s security or privacy but that of the Veteran or beneficiary as well as the potential exposure or wrongful disclosure of such information as a result of a failure to follow proper data security controls and protocols.

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

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

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

http://www.sam.gov/ http://www.acquisition.gov/far/

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

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

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

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

11. PROPOSAL DELIVERY: Offers shall be submitted electronically to Wyona Davis at wyona.davis@va.gov. Faxed offers will not be accepted. Mailed offers will not be accepted.

Multiple emails accepted for attachments exceeding 10MB.

a. PROPOSAL CHECKLIST:

• Complete blocks 17a and b and 30a through 30c on page 1 [Standard Form (SF) 1449]

• Complete Section B.1; 1a. Contract Administration (page 4)

• Offeror must be registered (and active) in the System for Award Management (SAM).

Instructions can be found in Section B.1

• Complete Section B.1: Acknowledgement of Amendments and return amendment(s) (if applicable) signed by the same official that signed the SF 1449 (box 30a).

• Complete B.5 Price/Cost Schedule (starting on page 14). Follow all pricing instructions. Price proposals should use the same per diem rates for the base year and all option years.

• Provide the most recent State survey, deficiencies, corrective action plans and concurrence

• Provide evidence of the following:

o State Licensure o Current Center for Medicare and Medicaid Services (CMS) certification o Medical Liability Insurance

• Provide a copy of your 2021 NC Medicaid per diem rate

• Provided Signed Copy of QASP See Section D.1

• Provided Signed Copy of VA Privacy and Information Security Awareness and Rules of Behavior See Section D.2

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

AMENDMENT NO DATE

This is a basic ordering agreement for the period from the effective date to the contract expiration date, in accordance with FAR 16.7. A contract is formed, in accordance with the terms and conditions of this agreement, when 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 Department of Veterans Affairs (VA), all terms and conditions of this agreement shall apply during such time as a VA patient remains in that nursing home at the expense of VA.

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 B.4 of this agreement. VA is obligated only to the extent authorized placements of patients are made under this agreement.

B.2 SCHEDULE OF ITEMS

1. 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).

The VA is seeking preferred rates, based on patient care need. VA rates are an all-inclusive per diem rate. The per diem rate(s) will apply throughout the term of this Indefinite Delivery

Contract (IDC). While the VA uses State Medicaid rates as a reference, VA rates are independent of those payment systems and governed by the terms of this contract. The per diem rate utilizes the Resident Assessment Instructions (RAI)/Minimum Data Set (MDS) assessment and RUGS score as the reference for rates. The VA reserves the right to request a resident re-assessment at any time during the coverage period.

2. Rate Adjustments: Rate adjustments may be requested by either the VA or the Contractor’s authorized Community Nursing Home (CNH) representative during the term of this contract.

Request for Rate adjustments must be accompanied by a justification for consideration by the

Contracting Officer. If approved, the contract must be modified and signed by both the

Contractor and the VA Contracting Officer. The effective date of the rate adjustment will be the actual “Effective Date” as indicated on the contract or the modification.

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

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.

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

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

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

(including ventilator and supplies).

7. Specialized Prosthetics Equipment (e.g., special bed and/or bariatric equipment):

Veterans may be eligible for specialized equipment when clinically indicated. Pre-approval required by VA.

SERVICE

COVERED

BY PER-

DIEM

NOT

COVERED

BY PER

DIEM*

NOTES

Audiology Care X Pre-approval and special authorization required

Beds (Specialized) X Pre-approval and special authorization required

Dental Care (Routine) X

Dental Care

(Extensive) X

Pre-approval and special authorization required

Dialysis X Pre-approval and special authorization required

Durable Medical

Equipment X Can be obtained through VA

Emergency Room/

Urgent Care Visits X

Refer to Performance Work

Statement (PWS) #10 and #16

Eye Care (Routine) X

Hospice Care X Pre-approval and special authorization required

Hospitalizations X Refer to Performance Work

Statement (PWS) #10 and #16

IV Therapy X

Lab Tests X

Laundry/Linen

Service X

Medications X See Schedule of Items (#4)

Mental Health

(Routine) X

Medication review as required by

North Carolina State regulations

Nursing Care

(Routine) X

Nursing Supplies X

Occupational Therapy X Pre-approval required

Oxygen Therapy X

Pastoral Care X

Physical Therapy X Pre-approval required

Podiatry Care

(Routine) X

Private Room X See Schedule of Items (#5)

Prosthetics (Custom) X Pre-approval and special authorization required

Provider Visits

(MD/NP)

X

Psychology Services X Pre-approval and special authorization required

Radiology Studies

(Routine) X All others need to be pre-authorized

Respiratory Therapy

(Routine) X

Room and Board X

Social Services X

Speech Therapy X Pre-approval required

Swallowing

Evaluation

(Diagnostic) X Pre-approval required

Therapeutic

Recreational Services X

Transportation X Pre-approval required; on a case-by-case basis

Ventilator Care X See Schedule of Items (#6)

Wound Care X

B.3 ORAL MEDICATIONS

Oral medications, which comprise more than 8.5% of the per diem rate on a monthly basis, are excluded from that rate. High drug costs will be determined or priced using the Average

Wholesale Price (AWP) of the drugs plus a transaction fee of 3% per month. All calculations will be made on a monthly basis. When a high cost drug patient is identified, VA staff must be advised promptly to establish an appropriate course of action, which may include the provision of the medications by VA.

B.4 LEVELS OF CARE/RUGs IV DESCRIPTIONS

Level of Care determinations are based on the Resource Utilization Groups (RUGS-IV) case-mix. A case-mix system categorizes patients into groups according to their level of care needs.

RUGS-IV, like other case-mix systems, defines patients for clinical and reimbursement purposes.

Rehabilitation Plus Extensive Services: Residents satisfying all of the following three conditions: Having a minimum activity of daily living (ADL) dependency score of 2 or more.

Receiving physical therapy, occupational therapy, and/or speech-language pathology services while a resident. While a resident, receiving complex clinical care and have needs involving tracheostomy care, ventilator/respirator, and/or infection isolation. RUG Scores: RUX, RUL, RVX, RVL, RMX, RHX, RML, RHL, RLX.

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

Extensive Services: Residents satisfying the following two conditions: Having a minimum

ADL dependency score of 2 or more. while a resident, receiving complex clinical care and have needs involving: tracheostomy care, ventilator/respirator, and/or infection isolation. RUG Scores:

ES3, ES2, ES1.

Special Care High: Residents satisfying the following two conditions: Having a minimum

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

Special Care Low: Residents satisfying the following two conditions: Having a minimum

ADL dependency score of 2 or more. Receiving complex clinical care or have serious medical conditions involving any of the following: cerebral palsy with ADL dependency score of 5 or more, multiple sclerosis with ADL dependency score of 5 or more, Parkinson’s disease with

ADL dependency score of 5 or more, respiratory failure and oxygen therapy while a resident, tube feeding meeting intake requirement, ulcer treatment with two or more ulcers including venous ulcers, arterial ulcers or Stage II pressure ulcers, ulcer treatment with any Stage III or

IV pressure ulcer, foot infections or wounds with application of dressing, radiation therapy while a resident, or dialysis while a resident. RUG Scores: LE2, LE1, LD2, LD1, LC2, LC1, LB2, LB1.

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

Behavioral Symptoms and Cognitive Performance: Residents satisfying the following two conditions: Having a maximum ADL dependency score of 5 or less. Having behavioral or cognitive performance symptoms, involving any of the following: difficulty in repeating words, temporal orientation, or recall (score on the Brief Interview for Mental Status <=9), difficulty in making self-understood, short term memory, or decision making (score on the Cognitive

Performance Scale >=3), hallucinations, delusions, physical behavioral symptoms toward others, verbal behavioral symptoms toward others, other behavioral symptoms, rejection of care, or wandering. RUG Scores: BB2, BB1, BA2, BA1.

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

B.5 PRICE/COST SCHEDULE

The offeror shall furnish all personnel, professional and technical services, materials, supplies, equipment and qualified supervision as specified herein for off-site community nursing home

(CNH) services to eligible beneficiaries of the Veterans Affairs Medical Centers (VAMC) in the

North Carolina VA Healthcare Network (VISN 6).

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

• Cabarrus, North Carolina

• Cumberland, North Carolina

• Wake, North Carolina

Other counties may be added as the need presents.

Contract type: Fixed Price, Indefinite Delivery Contract (IDC) with Economic Price

Adjustment (EPA)

Authority: Title 38 U.S.C. 1720, Transfer to Nursing Home Care Authority, Federal

Acquisition Regulation (FAR) Part 12, Acquisition of Commercial Items in conjunction with

FAR Part 15, Contracting by Negotiation.

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

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

Contract Minimum/Maximum: Multiple awards are anticipated in order to accommodate the various VAMCs and catchment areas in the State of North Carolina within the VISN 6 catchment area. Veterans will be placed in the facility that most adequately meets their needs. It is impossible to determine the exact or estimated amount which will be expended under this

IDIQ. No obligation will be incurred by the VA under this IDIQ until authorizations are issued for nursing home care of specific beneficiaries. The maximum contract amount for any contract awarded as a result of this solicitation shall not exceed $7,000,000.00. A task order shall be issued at the start of each period of performance and not by Veteran/patient.

Note: The Government reserves the right to send patients to facilities other than the offeror.

VA acknowledges that, depending on the availability of resources during specific times, acceptance of a referral may be commercially impracticable for the CNH. In that event, the

CNH may decline to accept an authorization. If the CNH has determined that space is not available and will not accept the Veteran, the VAMC will seek another CNH for placement.

In accordance with FAR 16.505(b)(2)(i)(A) or FAR 16.505(b)(2)(i)(B), VA has determined it is in the best interest of the Veteran to place the individual order without further competition because the need for these services is sometimes urgent and providing the opportunity to all

CNHs would result in unacceptable delays in fulfilling that need. The CNH will primarily be selected based on the Veteran’s needs and proximity to the Veteran’s home and/or family.

Pricing Instructions: Pricing is based on Medicaid rates. A copy of the Medicaid rate for the

Offeror’s facility must be provided.

An IDC will not be awarded until a patient need has been identified and acceptance of the referral has been made. The Offeror agrees to hold the prices in its offer firm through the end of the base year.

If a service is not provided at the offeror’s facility, indicate Not Applicable (NA) on the pricing schedule. NOTE: The same per diem rates shall be used for the base year and all option years in the offeror’s proposal. These per diem rate(s) will apply throughout the term of the IDC.

However, per diem rate adjustments can be requested by either the VA or an authorized CNH representative at any time (not to exceed one per year).

https://acquisition.gov/far/current/html/Subpart%2016_5.html#wp1095799 https://acquisition.gov/far/current/html/Subpart%2016_5.html#wp1095799

Rate adjustments are not effective until the IDC modification is signed by both the Contractor and the VA Contracting Officer. The effective date of the rate adjustment will be the actual

“Effective Date” as indicated on the IDC or the modification.

Base Year: (dates TBD upon award)

ITEM

DESCRIPTION OF

SUPPLIES/SERVICES QUANTITY UNIT AMOUNT

1 DAY $__________________

Rehabilitation Plus Extensive Services: RUX, RUL, RVX, RVL, RHX, RHL, RMX, RML, RLX

Contract Period: Base

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

Extensive Services: ES3, ES2, ES1

Special Care High: HE2, HE1, HD2, HD1, HC2, HC1, HB2, HB1

Special Care Low: LE2, LE1, LD2, LD1, LC2, LC1, LB2, LB1

Clinically Complex: CE2, CE1, CD2, CD1, CC2, CC1, CB2, CB1, CA2, CA1

Behavioral Symptoms and Cognitive Performance: BB2, BB1, BA2, BA1

Reduced Physical Function: PE2, PE1, PD2, PD1, PC2, PC1, PB2, PB1, PA2, PA1

RHB, RHC, RMA, RMB, RMC, RLA, RLB

With Precautionary Isolation Add-On ($______)

HB1

CB1, CA2, CA1

BA2, BA1

PB2, PB1, PA2, PA1

COVID-19 Positive Patient

Option Year 1: (dates TBD upon award)

DESCRIPTION OF

Contract Period: Option Year 1

RHB, RHC, RMA, RMB, RMC, RLA, RLB

HB1

CB1, CA2, CA1

BA2, BA1

PB2, PB1, PA2, PA1

Option Year 2: (dates TBD upon award)

DESCRIPTION OF

Contract Period: Option Year 2

RHB, RHC, RMA, RMB, RMC, RLA, RLB

HB1

CB1, CA2, CA1

BA2, BA1

PB2, PB1, PA2, PA1

Option Year 3: (dates TBD upon award)

DESCRIPTION OF

Contract Period: Option Year 3

RHB, RHC, RMA, RMB, RMC, RLA, RLB

HB1

CB1, CA2, CA1

BA2, BA1

PB2, PB1, PA2, PA1

Option Year 4: (dates TBD upon award)

DESCRIPTION OF

Contract Period: Option Year 4

RHB, RHC, RMA, RMB, RMC, RLA, RLB

HB1

CB1, CA2, CA1

BA2, BA1

PB2, PB1, PA2, PA1

B.6 DESCRIPTION/SPECIFICATIONS/PERFORMANCE WORK STATEMENT

A. Overview

1. Federal Acquisition Regulation (FAR) – Indefinite Delivery Indefinite Quantity Contract

(IDIQ). In accordance with FAR 16.504, Indefinite Delivery Indefinite Quantity Contracts

(IDIQ), this is an IDIQ 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 Section B.4 of this

IDIQ. The VA “Levels of Care” are defined in Section B.4 of the solicitation and the IDIQ.

VA is obligated only to the extent authorized placement of patients is made in accordance with this IDIQ.

B. Background/Introduction. The Community Nursing Home (CNH) Program is a key component of the Veterans Health Administration (VHA) continuum of care. The Contractor agrees to provide services in accordance with the terms and conditions stated herein to the

U.S. Department of Veterans Affairs VAMC Health Care System, in North Carolina at the prices specified in the section titled Schedule of Items of this IDIQ. Nursing home facilities in the CNH Program shall cooperate with VA staff in 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.

C. Requirements

General. Nursing home facilities in the CNH Program shall ensure that care meets the health needs and promotes the maximum well-being of VA patients. 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 The Office of Community Care

(OCC) Field Guidebook (Specialty Programs Section 1.2 GEC) a copy of which is available at:

OCC Field Guidebook and VHA Notice 2020-32, N202032.pdf titled “Community Nursing

Home Program.” This notice addresses eligibility, inpatient respite care, extended care copayments, quality expectations, coordination and the CNH certificate report. 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 https://gcc02.safelinks.protection.outlook.com/?url=https%3A%2F%2Fdvagov.sharepoint.com%2Fsites%2FVHAOCC%2FCNM%2FCI%2FOCCFGB%2FSitePages%2FFGB.aspx&data=04%7C01%7C%7C67ae2c1c14f94cad7b4408d94096cb0e%7Ce95f1b23abaf45ee821db7ab251ab3bf%7C0%7C0%7C637611838652320848%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C1000&sdata=EYgEtJl%2BC3VgLoBogIbpfa2a%2Ftb%2F5tzKIbKbZzrO1yI%3D&reserved=0 file:///C:/Users/VHAHAM~1/AppData/Local/Temp/MicrosoftEdgeDownloads/739468a8-ccb3-40ae-a6bb-9a2e04db89e1/N202032.pdf 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 require

PRIOR APPROVAL for authorization for additional payment. Contract Nursing Home staff should follow Specialty Service/Rehab referral protocols as outline by the VAMC CNH Program staff.

1. VA Oversight Visits. Duly authorized representatives of the VA will provide quality oversight visits to Veterans placed to assure continuity of care, and 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 IDIQ will include the cost of primary medical care, one (1) provider visit per month 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 IDIQ for details regarding per diem rates and coverage). Full attention shall be given to motivating and educating patients to achieve and maintain independence in the activities of daily living. Every effort shall be made to keep patients ambulatory and to achieve an optimal level of self-care.

2. Termination of Services. 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.

3. Medicare/Medicaid Standards: The contractor is required to follow

Medicare/Medicaid standards for all VA placements, except Life Safety. Medicare and

Medicaid clinical and program standards are found in 42 CFR 483

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 a new VA Form 10-7078.

5. Medicaid-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

Medicaid 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. Medicaid Rate Determination. The per diem rate is established by the current Medicaid rate for Medicaid-approved nursing homes including the cost of supplies, services, and equipment above that provided under Medicaid. Rates established after the Effective Date of this IDIQ will require a modification to the IDIQ. 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 IDIQ 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/Medicaid: The

CNH’s Minimum Data Set (MDS) assessment will be completed on the same schedule as the current Medicare/Medicaid 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/Medicaid. 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. 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 IDIQ 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/Medicaid 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; 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 VAMC Clinical

Transfer Coordinators 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 VAMC’s

Contract Nursing Home Program Coordinator. The VA will monitor the professional care and administrative management of services provided to Veterans under this IDIQ, through one or any combination of the following methods: Reviews of State agencies reports; on-site inspection of the CNH by VA staff; and/or on-site monitoring of 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 IDIQ, including VA’s on-site inspection and monitoring. The VA Contracting Officer shall make all final determinations as to the Contractor’s reasonable cooperation with VA and compliance with these requirements.

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 contain elements detailing how the CNH will correct the deficiency as it relates to the individual;

a. indicate how the CNH will act to protect residents in similar situations;

b. 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;

c. 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

d. 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 IDIQ award and compliance with all applicable Federal, State and local regulations. The

Administrator of the CNH is required to notify the VA Contracting Officer in writing at least 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 IDIQ became effective. The VA Contracting Officer will notify the VA Safety Manager responsible for the Life Safety Code inspection of the CNH and he/she will review (inspect the facility if required) the proposed changes and provide necessary approval or disapproval of the CNH to house Veterans during and/or after the proposed changes. These changes may include but are not limited to:

a. Interior changes requiring VA approval. Some examples of facility changes that require the VA Contracting Officer notification are as follows: interior finish, corridor partitions/walls, patient room doors, linen or trash chutes, exits, emergency lighting, fire alarm systems, automatic sprinklers, smoke barrier walls or doors, oxygen systems, compressed gas storage, HVAC, electrical and fuel gas systems;

b. Automatic sprinkler system. All VA contracted CNH facilities are to be fully equipped with a…