36C24723R0089 ATL VAMC OandC RFP CNH SVS.docx

36C24723R0089

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.

UEI:

EFT:

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

06-01-2023 Marvin Butler marvin.butler@va.gov 05-31-2024

Department of Veterans Affairs VISN 7 Network Contracting Activity 501 Greene Street Hatcher Building - Suite 2 Augusta GA 30901

X

623110

N/A

VISN 7 Network Contracting Activity 501 Greene Street

Augusta GA 30901

Department of Veterans Affairs VISN 7 Network Contracting Activity 501 Greene Street Hatcher Building - Suite 2 Augusta GA 30901

FMS-VA-2 (101)

Financial Services Center P.O. Box 149971 Austin TX 78714-9971

As a result of this Request for Proposal (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 various counties within a geographical area of the Atlanta VAMC. Award will be made to qualified

Nursing as the need arises in their respective county.

The resulting Contract can be up to five years (i.e. one base year and four, one-year options.

See Addendum 52.212-1 and 52.212-2 for instructions on submitting proposals.

Submit all questions and proposals to Contract Specialist, Brittney Ferguson at Brittney.Ferguson@va.gov and Contracting

Officer, Ben Butler at Marvin.Butler@va.gov

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 36C247

VISN 7 Network Contracting Activity 501 Greene Street Hatcher Building - Suite 2 Augusta GA 30901

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.

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

36C24723R0089

Page 1 of Page 1 of

B.2 PERFORMANCE WORK STATEMENT (PWS)

A. Overview

1. Federal Acquisition Regulation (FAR) – Indefinite Delivery Indefinite Quantity Contract (IDIQ). In accordance with FAR 16.504, Indefinite-Quantity Contracts, this is an IDIQ with an ordering period of up to five years beginning from the date of award. This requirement is being solicited under the authority of 38 CFR 17.4000, 38 U.S.C. 1710 and 38 U.S.C. 1720.

2. Services Rendered at VA Per Diem Rates. Upon acceptance of a VA patient by the Community Nursing Home (CNH), when requested by the VA Contracting Officer or authorized representative, the Contractor shall furnish all supplies and services herein described, at the per diem rates for the “Levels of Care” specified in the Schedule of Items of this IDIQ. The VA “Levels of Care” are defined in an attachment in Section D.1 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 in accordance with the terms and conditions stated herein to the U.S. Department of Veterans Affairs Atlanta Health Care System, 1670 Clairmont Rd, Decatur, Georgia 30033 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 referral of appropriate Veterans for care and accept Veterans of which they have the capability/capacity to care. The term, “facilities,” shall include but not be limited to rooms, wards, sections, eating areas, drinking fountains, entrances, and other like areas. VA shall have the right to inspect the CNH and all appurtenances by authorized VA representative(s) to ensure that acceptable standards are maintained and that the necessary care to maintain the well-being of the patient is rendered.

C. Requirements

General. Nursing home facilities in the CNH program shall ensure that care meets the health needs and promotes the maximum well-being of VA patients. 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 Medicaid and Medicaid Services (CMS) certification (Medicaid and/or Medicaid) and a state nursing home license. VA developed quality of care standards utilizing CMS inspection criteria that are followed by VA in its selection of nursing homes which includes exclusionary criteria on which the CNH is evaluated. See VHA Handbook 1143.2, “VHA Community Nursing Home Oversight Procedures (June 4, 2004) a copy of which is available at:

https://dvagov.sharepoint.com/sites/VHAOCC/CNM/CI/OCCFGB/SitePages/FGB.aspx http://www.va.gov/vhapublications/publications.cfm?pub=2

VA often has a need for specialty care services in the CNH program. The VA requires CNHs to have bed capacity to ensure their ability to take referrals when requested. The CNH also must be able to accept VA referrals in a timely fashion (ideally within 24 hours of request). Provider visits will be available at the rate of one (1) visit per month. Laboratory, x-ray, and other special services will be available to VA patients as needed. In addition, the care provided will include room, meals, nursing care, and other services or supplies commensurate with the VA-authorized level of care, without extra charge.

It is the responsibility of the CNH contract providers to immediately notify the VA Contract Officer II and biller to resolve all contract-related updates. This includes but is not limited to: tax id changes, ownership changes, and Sams.gov updates. Also, the CNH contract providers will forward the completed VA form 10091 with W-9, and novation agreement to VA Central billing in Austin, TX.

a. VA Central billing, in Austin, TX, updates vendor profiles and issues payment. VA Central billing customer support #’s is (512) 460-5380 or toll free (877) 353-9791.

b. If 1b & 1c updates are not accurately and promptly communicated, invoices can be rejected, and payments can be delayed. VA CNH program, VA Payment Operating Management (POM) department can impose other requirements in accordance with VA guidance.

c. It is the responsibility of the CNH contract providers to review and assure accuracy of invoices and submit via e-fax by the 15th of every month. Corrected invoices, to include pharmacy charges, must be submitted and resolved within 30 days of VA notification. Facility/owner invoices must sign and certify all charges upon submission to the VA. VA will pay, deny, or otherwise adjudicate the claim within 30 calendar days of receipt of the requested information. If a corrected invoice is submitted after payment is rendered, it may be required to return original payment for a new payment to be rendered. Invoices shall be submitted to:

Candyce Jackson, Program Support Assistant Atlanta VA Medical Center Social Work Service Line Candyce.Jackson@va.gov

3. VA Oversight Visits. Duly authorized representatives of VA will provide quality oversight visits to Veterans placed to assure continuity of care and to assist in the Veterans’ transition back into the community. These visits do not substitute nor relieve the CNH in any way of the responsibility for the daily care and medical treatment of the Veteran. The per diem rate(s) established in your contract 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.

4. Ordering. Orders will be issued by Ordering Officers to place Veterans in Nursing Homes, often on a sole source basis using an Exception to Fair Opportunity and utilizing the CPRS system at VA hospital sites (Reference FAR 16.505 (b)(2)(i)(B)). Ordering Officer Contact information is as follows:

Kim Whitmoyer, LCCSW

Nakkia King, LCSW, DCSW

kim.whitmoyer@va.gov nakkia.king@va.gov

5. Termination of Services. VA reserves the right to remove any or all VA patients from the CNH at any time when it is determined to be in the best interest of VA or the patients without additional costs to the Government. If the nursing home request termination contract, a written notice with justification is required, which will be reviewed by VA local and Regional Contracting Office.

6. 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, and break in treatment beyond bed-hold days requires a new VA Form 10-7078.

7. Medicaid-Based Rates. The current State Medicaid rates may be used as a basis for determination of VA rates. VA contract rates can be revised annually-per the term on the contract, in which are at the discretion of the VA Regional Contracting Office. The VA rate will include medical care, routine 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 (RUG-IV) as a guide. As with Medicaid, a description of the RUG-IV systems can be found in 42 CFR Parts 409, et al.

8. Medicaid Rate Determination. The per diem rate will be established by utilizing the current Medicaid rate including the cost of supplies, services, and equipment above that which is provided under Medicaid. 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, most items of 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.

9. 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 VA, dependent on projection for short-term or long-term residence, 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. This request should be submitted on the Level of Care Authorization Form provided to the facility. VA will make the determination whether classification changes require readmission to VA. VA staff will audit approximately 20% of the MDS assessments.

10. Primary Medical Coverage. The assigned CNH contract provider is the primary medical provider during the nursing home stay and is responsible for writing or approving admission and all other orders as soon as the Veteran arrives at the CNH. The CNH contract provider is responsible for general medical care, urgent evaluation, and intervention. Provider visits will be according to the Center for Medicare and Medicaid Services (CMS) guidelines. The assigned CNH contract providers 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).

11. 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 may require pre-approval by VA before services are provided and to extend services. Medical Restorative criteria will be used for physical therapy, occupational therapy, and speech therapy. Therapy must be skilled, relate to safety and be restorative according to Medicare criteria.

a. Description of Rehabilitative Therapy. The concept of rehabilitative therapy includes recovery or improvement in function and, when possible, restoration to a previous level of health and well-being. Therefore, evaluation, re-evaluation and assessment documented in the Progress Report should describe objective measurements which, when compared, show improvements in function, or decrease in severity, or justification for an optimistic outlook to justify continued treatment. Covered therapy services shall be rehabilitative therapy services unless they meet the criteria for maintenance therapy requiring the skills of a therapist.

b. Evaluations/re-evaluations should consider the following: Establishment of treatment goals specific to the patient’s disability or dysfunction and designed to specifically address each problem identified in the evaluation; design of a plan of care addressing the patient’s disorder, including establishment of procedures to obtain goals, determining the frequency and intensity of treatment; continued assessment and analysis during implementation of the services at regular intervals; instruction leading to establishment of compensatory skills; selection of devices to replace or augment a function (e.g., for use as an alternative communication system and short-term training on use of the device or system); and patient and family training to augment rehabilitative treatment or establish a maintenance program. Education of staff and family should be ongoing.

12. Emergency Care; Financial Responsibility; Advanced Directives. In emergencies, nursing home staff will utilize the 911 local emergency systems as for any resident. Advance directives or living wills shall be adhered to according to CNH physician’s orders. When private hospitalization or emergency services are required, the patient, spouse, financial guardian, or insurer is financially responsible. Service-connected Veterans may qualify for VA coverage of emergency care provided the VA Health Care System (VAHCS) is contacted by the private hospital provider within 72-hours of admission on the first business day following a weekend or holiday. This includes the cost of necessary transportation for such care.

13. HIPAA Compliance. HIPAA compliance is required. The Contractor must adhere to the provisions of Public Law 104-191, Health Insurance Portability and Accountability Act (HIPAA) of 1996 and the National Standards to Protect the Privacy and Security of Protected Health Information (PHI). As required by HIPAA, the Department of Health and Human Services (HHS) has promulgated rules governing the security and use and disclosure of protected health information by covered entities, including the Department of Veterans Affairs (VA). In accordance with HIPAA, the Contractor may be required to enter into a Business Associate Agreement (BAA) with VA, but VACO has recognized CNH Facilities as an entity that does not require a BAA if they are conducting health care on VA’s behalf. The CNH care program qualifies as a medical service, so no BAA is required.

14. Information Security Requirements: The CNH is responsible for training, National Rules of Behavior and background investigation. The CNH should notify the VA of any security breaches or risks within 24 hours. Contractors, contractor personnel, subcontractors, and subcontractor personnel shall be subject to the same Federal laws, regulations, standards, and VA Directives and Handbooks as VA and VA personnel regarding information and information system security. A contractor/subcontractor shall request logical (technical) or physical access to VA information and VA information systems for their employees, subcontractors, and affiliates only to the extent necessary to perform the services specified in the contract, agreement, or task order. Emails including veteran sensitive information must be encrypted.

15. Encrypted Emails/Secure Messaging: VA Direct Messaging is an enterprise-wide web application that allows users to securely send and receive Veteran health information with community care providers. The goals of VA Direct Messaging are, but not limited to:

1. continuity of care

2. coordination of care

3. reliable communication stream

4. communication tracking

VA Direct Messaging can help to eliminate or reduce the burden of administrative tasks such as faxing, mailing, or hand-delivering health information. It is a requirement of the nursing home to test and assure this system is in place for the duration of the contract. It is required that your facility enroll, complete required testing, and train necessary staff in order to comply with this requirement.

Website: https://www.va.gov/vhie/ Contractor in Support of VHIE Program Implementation Office: 910.818.8710

16. 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 Atlanta VA Health Care System, Contract and Community Care Department at (404) 521-6260 Ext. 558421. VA will monitor the professional care and administrative management of services provided to VA beneficiaries 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 VA patients. The CNH shall provide VA with copies of all State agency reports when requested and cooperate fully with VA’s quality improvement or quality assurance program functions relating to this 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.

17. Corrective Action Plan (QASP Indicator #2). The CNH will cooperate with timely development of Corrective Action Plans (CAPs) related to identified deficiencies and related to State, Federal or VA surveys. The CNH will develop in the time period specified by VA timely and appropriate CAPs for VA surveys or investigation of complaints related to quality of care or sentinel events. The CNH will also supply related documents or data as specified by VA. The CAPs will include but are not limited to the following criteria and shall:

a. Contain elements detailing how the CNH will correct the deficiency as it relates to the individual;

b. Indicate how the CNH will act to protect residents in similar situations;

c. Include the measures the CNH will take or systems that will be altered to ensure that the problem will not recur. The CNH must look at the system and determine if a change to the existing system will work, if a new system is necessary, or if a system does not exist and must be developed;

d. Indicate how the CNH plans to monitor performance to make sure that solutions are permanent. The CNH must develop a quality assurance tool for ensuring that correction is achieved and sustained. This tool must be implemented. Failure to implement a quality assurance tool to sustain compliance will reflect that the CNH has an ineffective quality assurance system; and

e. Provide dates when corrective action will be completed.

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

b. Automatic sprinkler system. All VA contracted CNH facilities are to be fully equipped with a fully automatic sprinkler system installed in accordance with the National Fire Protection Association’s (NFPA) standards and be 100% sprinklered;

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

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

19. Acceptable Safety and Sanitation Practices. Acceptable safety and sanitation practices shall be observed throughout the facility. The CNH will address employee and patient safety practices through staff orientation, training and adherence to related policy or procedures to provide a safe and clean environment.

20. The Veterans Health Administration (VHA) conducts the annual Community Nursing Home (CNH) assessment to ensure VHA is making sound clinical and business decisions by purchasing skilled nursing and rehabilitation care at CNHs. This is an in-person discussion, unless otherwise directed by the VA medical center chief of staff, with CNH leadership; this is generally the administrator, director of nursing, and director of admissions. This discussion should cover three topics:

a. Veterans’ experience at a CNH as documented during VHA staff on-site resident assessments, and/or as feedback from Veterans families or caregivers.

b. Review of CNH’s current Medicare Nursing Home Compare scores.

c. Plans to maintain or improve care over the coming year.

21. Re-admission to the VA Hospital and Emergency Care; Notification of Death of Veterans; CNH Responsibility to Veteran’s Belongings or Personal Effects (QASP Indicator #3). VA beneficiaries who begin to require more than the level of care authorized by VA will be readmitted to an appropriate VA facility, as determined and authorized by VA.

a. When such an admission is not feasible because of the nature of the emergency, hospitalization in a non-Federal facility may be accomplished provided VA authorization is obtained. VA authorization must be obtained within 72-ours of admission of the patient to a non-Federal facility and notice of any Veteran death within 24-hours or immediately the first business day after a weekend or holiday. If hospitalization of a non-emergency nature is required, readmission to a VA Medical Center may be accomplished as soon as the patient’s condition is sufficiently stabilized to permit admission to a VA Medical Center.

b. In the event of a death of any Veteran, the Contractor agrees to notify VA immediately of the death and provide VA Descendant Affairs contact information to the family. In the event a death of a VA beneficiary while receiving nursing home care under this IDIQ, the CNH will promptly notify the VA facility which authorized admission and immediately assemble, inventory, and safeguard the patient’s personal effects. The funds, deposits, and effects left by the VA patients upon the premises of the CNH shall be delivered by the CNH to the person(s) entitled thereto under the laws currently governing the CNH for making disposition of funds and effects left by patients, unless the beneficiary died without leaving a will, heirs or next of kin capable of inheriting.

c. When disposition has been made, the itemized inventory with annotation as to the disposition of the funds and effects will be immediately forwarded to the VA facility authorizing admission. Should a deceased patient leave no will, heirs, or next of kin, his/her personal property and funds wherever located vests in and becomes the property of the United States in trust. In these cases, the CNH will forward an inventory of any such property and funds in its possession to the VA facility authorizing admission and will hold them (except articles of clothing necessary for proper burial) under safeguard until instructions are received from VA concerning disposition. CMS regulations require retention of records for five (5) years when there is no requirement in State law.

22. Leave of Absence (LOA) – Bed-Hold Statement. For re-hospitalizations or therapeutic passes, VA will pay a bed hold. Therapeutic passes will be authorized by the VA CNH staff based on individual patient needs and provider medical clearance. The provider will obtain VA clearance with 72 hours of bed-hold request date. LOA/Bed-hold are generally limited to seven (7) times per year and should be pre-approved by the VA. VA will cover bed holds based on the following plan:

The host VA medical center will follow below regarding hospitalizations:

a. Seven to fifteen (7-15) days per month (per the contract), with VA CNH staff notification within 72 hours of hospitalization is acceptable. VA authorization is required by VA when a Veteran is hospitalized as this is in the best interest of the Veteran and VA. Exceptions are approved at VAMC level;

b. Follow Medicaid - Rule would differ by State;

c. When deemed appropriate, VA will reimburse the CNH at the base Medicaid rate not to exceed seven to fifteen (7-15) days per month (does not need to be consecutive). Veteran may be discharged from CNH after 15 days;

d. VA will reimburse according to the prevailing State Medicaid guidelines.

The Bed-Hold will begin on the date that the Veteran leaves the CNH and will be paid at the lowest per diem rate on the Rate Schedule. The only exception to using the lowest per diem rate for Bed Holds is for CNH’s that provide Ventilator beds, which are in short supply and often high demand. For Ventilator beds, the Bed Hold rate will remain the regular Ventilator Bed rate. The appropriate RUG Level of Care per diem rate will resume on the date of the Veteran’s re-admission to the CNH. After an absence of fifteen (15) consecutive calendar days, whether in a VA or in a non-Federal facility, the Veteran must be discharged from the VA Contract Nursing Home Program, and a new authorization agreement will be required. After the VA’s 15-day bed hold, the nursing home would be responsible for notifying the family if a private-pay Bed Hold is recommended for a longer period. The family would then decide whether or not to continue to hold the bed and make any payment arrangements directly with the nursing home. If authorized by the referring VAMC, the VA will reimburse according to the prevailing State Medicaid guidelines.

23. Reportable Events (QASP Indicator #4). VA requires CNHs to report to the assigned VA Nurse and/or Social Worker and CNH Coordinator at VA any of the following events within 24-hours or immediately the first business day after a weekend or holiday:

1. Sentinel events;

2. When there is a change of ownership of the CNH

3. When there is a change of nursing home administrator or Director of Nursing/Director of Nursing Service;

4. substantiated allegations of mistreatment, neglect, abuse or misappropriation of CNH Veterans or property;

5. Elopements of CNH Veterans pursuant to state regulations;

6. Infectious outbreaks;

7. Resident to resident or resident to staff altercations involving a CNH Veteran resulting in any injury that is other than minor;

8. Copies of annual surveys or substantiated complaint investigations conducted by a State oversight agency; and

9. Adverse events. Reporting shall include date of occurrence and patient disposition and outcome.

A sentinel event may include, but is not limited to the following:

1. A fall resulting in death or injury;

2. Elopement resulting in a missing patient;

3. Patient abuse confirmed or under suspicion;

4. A medication error resulting in patient illness or injury;

5. Death or patient injury related to restraint (including side rails) use; or

6. Death related to an unconfirmed or suspicious cause.

When an adverse event occurs involving a CNH Veteran which is not determined to be a Sentinel Event (but that the State requires that the occurrence be reported to the State), such event is also to be reported to VA’s CNH program office, and if deemed patient safety concern or near miss will be reported via Joint Patient Safety Reporting online system. Some adverse events, such as minor medication errors without catastrophic outcomes, are managed by the CNH in the context of their quality improvement programs. It is not necessary for nursing homes to report such incidents to the CNH program office.

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

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

b. Suspend placement of Veterans in the CNH;

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

d. Not renew the IDIQ; and/or

e. Terminate the IDIQ.

25. VA Staff Access to CNH Records (QASP Indicator #5). All medical records concerning the Veteran’s care in the CNH will be readily accessible to VA remotely, in-person, and upon request. In that, VA designated staff will be given a username and password to access the nursing electronic medical records remotely and while conducting on-site visits. Upon discharge or the death of a patient, medical records will be retained by the CNH for a period of at least five (5) years following termination of care. Patient records will be maintained in conformance with the Privacy Act of 1974 (5 U.S.C. § 552a). A medical record shall be maintained for each patient, which includes at least the following:

a. VAHCS Referral Package to the CNH:

1. Copy of Physician Orders for Nursing Home Care; CPRS Notes; Discharge Summary including History & Physical information with Medication List; Rehabilitation Progress Notes; and Veteran Demographic Record which includes next of kin information.

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

b. Nursing Home Clinical Record: The CNH must maintain clinical records on each Veteran in accordance with accepted professional standards and practice. The clinical record must be complete, accurately documented, readily accessible, systematically organized, and legible. Remote Electronic Medical Records (EMR) access is to be provided to VA CNH staff for the length of the contract to assure clinical timely medical record reviews and records have the necessary information. Additional clinical records may be requested. Clinical records must contain at a minimum:

1. Sufficient information to identify the resident;

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

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

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

5. Medical practitioner orders which are signed and dated;

6. Allergies;

7. Person to contact in an emergency situation;

8. Name of attending medical practitioner; and

9. Advanced directives if available

10. Updated MDS with completed fields:

Item Z0200 (State Medicaid Billing) and Item A2300 (Assessment Reference Date [ARD]), Item Q0300 (Resident’s Overall Expectation), Item Q0500 (Return to Community)

11. Occurrence of falls, injuries, new onset and/or worsening of pressure sores, elopement attempts, medication errors, physical or chemical restraint use, unplanned weight loss greater than five (5) percent in three (3) months, symptoms of dehydration, loss of activity of daily living function, unanticipated deaths, complaints, and/or other adverse events

12. Emergency room visits or unplanned re-admissions to acute care facility that are suggestive of poor-quality care

13. Documentation requirement – social worker: every 3 months; Nursing: monthly; MDS: every 3 months.

c. If circumstances arise causing the VA staff to suspend on-site visits, a monthly care plan meeting is between the VA and nursing home staff in order to properly review each contract veteran case. The VA will initiate scheduling such meeting. Additional medical records may be requested to be e-faxed to the VA.

d. COVID data: At any time, the VA may request the facility COVID data to reflect residents and staff covid positivity, vaccinations, prevention methods, etc. To safeguard the residents and staff, if a COVID outbreak is suspected, a COVID checklist will be given to the CNH for completion in order determine if a VA contract placement suspension should be granted. If granted, the suspension will last a recommended amount of time or until the outbreak has subsided and resident safety prevention plan is in place. A revised COVID checklist, reflecting updated COVID data will be required to consider lifting the suspension.

e. Clinical Record Safeguards: The CNH must safeguard clinical record information against loss, destruction, or unauthorized use. If the CNH maintains a Veteran’s record by computer, electronic signatures are acceptable. If attestation is done on computer records, safeguards to prevent unauthorized access and to provide for reconstruction of information must be in place.

f. Waivers/Contracts: Community Nursing Homes (CNHs) that fall into the “eligible with waiver” category will need a Waiver for VHA to utilize this facility for Veterans’ CNH care. CNHs in the “eligible without waiver” category do not need waivers. This waiver process applies to CNH local contracts and Veterans Care Agreements (VCAs).

Threshold standards are solely based on Medicare Nursing Home Compare scores, as displayed below:

The Waiver Corrective Action Plan (CAP) will be created by the VA CNH staff and forwarded to the CNH contract provider for completion within 14 business days of receipt. The CNH will attach all supporting documentation to include recent Casper report, staffing logs, final State Inspection report with proof tags were resolved, and other documentation upon request.

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

27. VA Health Care System Consultation/Resources.

a. TAP Line: For urgent same-day outpatient specialty care or for non-urgent scheduled clinic appointments/consultations, (404) 329-2222 between 9 a.m. and 3 p.m. Monday through Friday, excluding holidays. If a same-day appointment is anticipated; please call as early as possible.

b. TAP Line phone number #:(404) 329-2222 For non-emergency consultation or /evaluation for admission to the Atlanta VA Health Care System (after initial evaluation or intervention by the nursing home physician).

c. After hours, weekends and holidays: For urgent referrals or consultation contact the TAP Line (404) 329-2222

d. Transportation: Necessary transportation to and from the VA hospital for clinics, evaluation or hospitalization will be arranged and paid by the VA hospital for CNH patients when requested.

For Clinic appointments, call (404) 321-6111 Ext. 206616/207201/206543/124085/124082/124083/124084/124081

Administrative on Duty (AOD) between the hours of 7pm – 7am at 404-321-6111 ext. 207465

e. Decedent Affairs: Deceased Veterans please contact (470) 494-4312; Veterans Benefit Administration (VBA): (800) 827-1000

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

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

a. Pre-approves services billed by CMS procedures or CPT codes: All services which are pre-approved by VA as additional to the all-inclusive per diem rate must be billed according to CMS procedures or CPT codes. The CNH will be reimbursed based on local guidelines and VA pricing schedules. VA contract rates can be revised annually-per the term on the contract, which are at the discretion of the VA Regional Contracting Office.

b. High-cost drugs: All requests for additional reimbursement for high-cost drugs and corresponding billing are due as soon as possible, but no later than 30 calendar days from use of products. The IDIQ per diem rate includes 8.5% for medication expenses.

c. Invoices: It is the responsibility of the CNH contract providers to review and assure accuracy of invoices and submit via e-fax by the 15th of every month. Corrected invoices, to include pharmacy charges, must be submitted and resolved within 30 days of VA notification. VA will pay, deny, or otherwise adjudicate the claim within 30 calendar days of receipt of the requested information. If a corrected invoice is submitted after payment is rendered, It may be required to return original payment in order for a new payment to be rendered.

d. Billing checklist and supporting documentation must accompany the monthly invoices

e. It is the responsibility of the CNH contract providers to immediately notify the VA Contracting Officer and Accounting Tech to resolve all contract-related updates. This includes: tax id changes, ownership changes, and Sams.gov updates. Also, the CNH contract provider will forward the completed VA form 10091 with the W-9 and novation agreement to VA Central billing in Austin, TX.

f. VA Central billing in Austin, TX updates vendor profiles and issues payment. The customer support #’s is (512) 460-5380 or toll free (877) 353-9791.

g. If the tax id changes, ownership changes, and Sams.gov updates changes are not accurately and promptly communicated, invoices can be rejected, and payments can be delayed. VA CNH program, VA Payment Operating Management (POM) department can impose other requirements in accordance with VA guidance.

h. VA service authorizations and the CNH contract providers invoices must reflect accurate per diem rates, dates of service, vendor id #, and vendor address or risk the invoices being rejected and delays in payment.

30. Minimum Quantities; VA Payment. It is impossible to determine the exact or estimated amount, which will be expended under this IDIQ. No obligation will be incurred by VA under this IDIQ, until authorizations are issued for nursing home care of specific beneficiaries. VA agrees to make payment on a timely basis for services rendered in accordance with such authorizations upon receipt of proper invoices submitted by the CNH as outlined in this IDIQ. VA will make payment for the day a recipient enters the CNH but not the day the recipient leaves a CNH unless entrance and departure are on the same day, then payment will be made for one (1) day.

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

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

b. CNH contract providers who are not able to use the HIPAA-compliant transactions are not required to do so. All invoices are faxed to Candyce Jackson, PSA/Biller at (404) 639-9370. Supporting information for monthly invoices will be sent to:

Candyce Jackson Program Support Assistant/CNH Biller Social Work Service Line Atlanta VA Medical Center

(404) 521-6260 ext. 558437 Fax: (404) 639-9370 candyce.jackson@va.gov

END OF PERFORMANCE WORK STATEMENT

B.3 RUGS IV SERVICES SCHEDULE

NOTE: Medicaid Rates are subject to change as determined by the State of Georgia. CNH rates will be consistent with the current Centers for Medicare and Medicaid Services (CMS) rates. The VA Base rate will be applied to all levels of care. This is based on the most recent data on the national VA versus Medicaid reimbursement average. The CO shall negotiate within the allowable percentage range to arrive at the per diem rate.

Effective Date: 07/22/2022 Page 1 of 13 Revision: 01 Page 1 of

SECTION C - CONTRACT CLAUSES

C.1 52.212-4 CONTRACT TERMS AND CONDITIONS—COMMERCIAL PRODUCTS AND COMMERCIAL SERVICES (DEC 2022)

(a) Inspection/Acceptance.