36C24818R0308-001.docx

36C24818R0308

PAGE 1 OF

1. REQUISITION NO.

2. CONTRACT NO.

3. AWARD/EFFECTIVE DATE

4. ORDER NO.

5. SOLICITATION NUMBER

6. SOLICITATION ISSUE DATE

a. NAME

b. TELEPHONE NO. (No Collect Calls)

8. OFFER DUE DATE/LOCAL

TIME

9. ISSUED BY

CODE

10. THIS ACQUISITION IS

UNRESTRICTED OR

SET ASIDE:

% FOR:

SMALL BUSINESS

HUBZONE SMALL

BUSINESS

SERVICE-DISABLED

VETERAN-OWNED

SMALL BUSINESS

WOMEN-OWNED SMALL BUSINESS

(WOSB) ELIGIBLE UNDER THE WOMEN-OWNED

SMALL BUSINESS PROGRAM

EDWOSB

8(A)

NAICS:

SIZE STANDARD:

11. DELIVERY FOR FOB DESTINA-

TION UNLESS BLOCK IS

MARKED

SEE SCHEDULE

12. DISCOUNT TERMS

13a. THIS CONTRACT IS A

RATED ORDER UNDER

DPAS (15 CFR 700)

13b. RATING

14. METHOD OF SOLICITATION

RFQ

IFB

RFP

15. DELIVER TO

CODE

16. ADMINISTERED BY

CODE

17a. CONTRACTOR/OFFEROR

CODE

FACILITY CODE

18a. PAYMENT WILL BE MADE BY

CODE

TELEPHONE NO.

DUNS:

DUNS+4:

PHONE:

FAX:

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

SEE ADDENDUM

19.

20.

21.

22.

23.

24.

ITEM NO.

SCHEDULE OF SUPPLIES/SERVICES

QUANTITY

UNIT

UNIT PRICE

AMOUNT

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

25. ACCOUNTING AND APPROPRIATION DATA

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

ARE

ARE NOT ATTACHED.

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

ARE

ARE NOT ATTACHED

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

29. AWARD OF CONTRACT: REF. ___________________________________ OFFER

COPIES TO ISSUING OFFICE. CONTRACTOR AGREES TO FURNISH AND

DATED ________________________________. YOUR OFFER ON SOLICITATION

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

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

ADDITIONAL SHEETS SUBJECT TO THE TERMS AND CONDITIONS SPECIFIED

SET FORTH HEREIN IS ACCEPTED AS TO ITEMS:

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

AUTHORIZED FOR LOCAL REPRODUCTION

(REV. 2/2012)

PREVIOUS EDITION IS NOT USABLE

Prescribed by GSA - FAR (48 CFR) 53.212

7. FOR SOLICITATION

INFORMATION CALL:

STANDARD FORM 1449

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

SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL ITEMS

VA248-18-AP-2166

36C24818R0308 04-09-2018 Jonathan D. Locklear 813-631-2814 04-08-2019 04:30 P.M.

36C248 Department of Veterans Affairs Network Contracting Office 8 (NCO 8) 8875 Hidden River Pkwy Suite 525 Tampa FL 33637 X 623110 $27.5 Million X N/A X 36C248 Department of Veterans Affairs VISN 8 VAMCs

36C248 Department of Veterans Affairs Network Contracting Office 8 (NCO 8) 8875 Hidden River Pkwy Tampa FL 33637

Department of Veterans Affairs Financial Services Center P.O. Box 149971 Austin TX 78714-9971 This is an open and continuous solicitation for VISN 8 Community Nursing Home (CNH) services. The Government intends to award multiple contracts from this solicitation.

Indefinite Delivery - Indefinite Quantity (IDIQ) contracts will be awarded on an as needed basis under authority 38 U.S.C. 1720.

VISN 8 Locations:

North Florida/South Georgia (NF/SG) VA Healthcare System Orlando VA Medical Center (VAMC) James A. Haley Veterans Hospital (Tampa, FL) Bay Pines VA Healthcare System West Palm Beach VAMC; Miami VA Healthcare System VA Caribbean Healthcare System (San Juan, PR) The current wage determination listed on DOL's website will be the applicable wage determination included in any awarded contracts and updated if option years are exercised.

$0.00 X X X Yamil O. Rodriguez Contracting Officer Table of Contents

SECTION B - CONTINUATION OF SF 1449 BLOCKS

B.1 CONTRACT ADMINISTRATION DATA

(continuation from Standard Form 1449, block 18A.)

1. CONTRACT ADMINISTRATION: All contract administration matters will be handled by the following individuals:

b. GOVERNMENT: Contracting Officer (CO): Yamil O. Rodriguez 36C248 Department of Veterans Affairs Network Contracting Office 8 (NCO 8) 8875 Hidden River Pkwy, Suite 525 Tampa, FL 33637

Administrative Contracting Officers (ACO): Jonathan D. Locklear 36C248 Department of Veterans Affairs Network Contracting Office 8 (NCO 8) 8875 Hidden River Pkwy, Suite 525 Tampa, FL 33637

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 to the following email address:

FACILITY DRIVEN, WILL BE PROVIDED UPON AWARD

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

1. ATTENTION TO LARGE BUSINESS: Large businesses are to submit a Subcontracting Plan, in accordance with FAR 52.219-8 and FAR 52.219-9 with their proposal. Refer to Attachment D. 6. Goals are recommended and shall express in terms of percentages of total planned dollars. Subcontracting plan is to include a description of the principal types of supplies and services to be subcontracted out and identification of the types planned for subcontracting in the area of Small, Small Disadvantaged, Woman-Owned, Hub-Zone, Service Disabled Veterans and Veteran-Owned Small Business concerns.

In accordance with the United States Department of Veterans Affairs Office of Small and Disadvantaged Business Utilization (OSDBU) Subcontracting Plan Model the following goals are required for each of the socioeconomic groups: Small Business (including Alaska Native Corporations (ANC) and Indian Tribes) 17.0%, Service Disabled Veteran-Owned Small Business 5.0%, Veteran-Owned Small Business 7.0%, Small Disadvantaged Business (including ANC and Indian Tribes) 5.0%, Women-Owned Small Business 5.0% and HUBzone Small Business 3.0%. The offeror agrees, if awarded a contract, to use Service-Disabled Veteran-Owned Small Businesses or Veteran-Owned Small Businesses proposed as subcontractors in accordance with 852.215-70 included herein, eligible Service-Disabled Veteran-Owned and Veteran-Owned Small Business Evaluation Factors, or to substitute one (1) or more Service-Disabled Veteran Owned Small Businesses or Veteran-Owned Small Businesses for subcontract work of the same or similar value.

1. CAUTION: LATE submissions, Modifications, and Withdrawals: See Provision 52.212-1. All offers are subject to all terms and conditions of this solicitation.

1. POST AWARD ORIENTATION: The CO will schedule a post award orientation conference for contract orientation purposes as required by IL 003A3-12-04, http://www.va.gov/oal/docs/library/ils/il12-04.pdf

B.2 SUBCONTRACTING COMMITMENTS--MONITORING AND COMPLIANCE (JUN 2011)

This solicitation includes VAAR 852.215-70, Service-Disabled Veteran-Owned and Veteran-Owned Small Business Evaluation Factors, and VAAR 852.215-71, Evaluation Factor Commitments. Accordingly, any contract resulting from this solicitation will include these clauses. The contractor is advised in performing contract administration functions, the CO may use the services of a support contractor(s) to assist in assessing contractor compliance with the subcontracting commitments incorporated into the contract. To that end, the support contractor(s) may require access to the contractor's business records or other proprietary data to review such business records regarding contract compliance with this requirement. All support contractors conducting this review on behalf of VA will be required to sign an “Information Protection and Non-Disclosure and Disclosure of Conflicts of Interest Agreement” to ensure the contractor's business records or other proprietary data reviewed or obtained in the course of assisting the CO in assessing the contractor for compliance are protected to ensure information or data is not improperly disclosed or other impropriety occurs. Furthermore, if VA determines any services the support contractor(s) will perform in assessing compliance are advisory and assistance services as defined in FAR 2.101, Definitions, the support contractor(s) must also enter into an agreement with the contractor to protect proprietary information as required by FAR 9.505-4, obtaining access to proprietary information, paragraph (b). The contractor is required to cooperate fully and make available any records as may be required to enable the CO to assess the contractor compliance with the subcontracting commitments.

B.3 SUBCONTRACTING PLAN--MONITORING AND COMPLIANCE (JUN 2011)

This solicitation includes FAR 52.219-9, Small Business Subcontracting Plan, and VAAR 852.219-9, VA Small Business Subcontracting Plan Minimum Requirement. Accordingly, any contract resulting from this solicitation will include these clauses. The contractor is advised in performing contract administration functions, the CO may use the services of a support contractor(s) to assist in assessing the contractor's compliance with the plan, including reviewing the contractor's accomplishments in achieving the subcontracting goals in the plan. To that end, the support contractor(s) may require access to the contractor's business records or other proprietary data to review such business records regarding the contractor's compliance with this requirement. All support contractors conducting this review on behalf of VA will be required to sign an “Information Protection and Non-Disclosure and Disclosure of Conflicts of Interest Agreement” to ensure the contractor's business records or other proprietary data reviewed or obtained in the course of assisting the CO in assessing the contractor for compliance are protected to ensure information or data is not improperly disclosed or other impropriety occurs. Furthermore, if VA determines any services the support contractor(s) will perform in assessing compliance are advisory and assistance services as defined in FAR 2.101, Definitions, the support contractor(s) must also enter into an agreement with the contractor to protect proprietary information as required by FAR 9.505-4, obtaining access to proprietary information, paragraph (b). The contractor is required to cooperate fully and make available any records as may be required to enable the CO to assess the contractor compliance with the subcontracting plan.

B.4 PRICE SCHEDULE

The offeror shall furnish all personnel to provide services necessary to provide Off-Site Community Nursing Home services to eligible beneficiaries within the catchment areas of the following VAMCs: Bay Pines, Gainesville, Miami, Orlando, San Juan, Tampa, and West Palm Beach. All services shall be performed at the Offeror’s facility. The Offeror shall provide professional and technical services to include materials, supplies, equipment and qualified supervision specified herein.

CONTRACT TYPE: Fixed-Price, Indefinite Delivery – Indefinite Quantity (IDIQ), with Economic Price Adjustment (EPA).

AUTHORITY: In accordance with (IAW) Title 38 United States Code (U.S.C.) 1720; FAR Part 12, Acquisition of Commercial Items in conjunction with FAR Part 15, Contracting by Negotiation.

PLACE OF PERFORMANCE: Services shall be provided offsite at the Offeror’s Facility.

PERIOD OF PERFORMANCE: One (1) base year with four (4) – one (1) year options to be exercised at the sole discretion of the Government.

MINIMUM AND MAXIMUM GUARANTEED: This contract includes a guaranteed minimum of $2,500.00 of services for the base year of the contract. The maximum amount to be ordered for this contract for the base, and all option periods, if exercised by the Government, is $6,900,000.00. If the maximum aggregate amount of $6,900,000.00 is reached prior to the end date of the final period of performance, no further task orders will be issued on the contract.

NOTE: All quantities are estimates only. The Government reserves the right to send patients to facilities other than the Offeror should the Veterans Affairs Medical Center (VAMC) physician determines it to be in the best interest of the patient. Per procedure contracts for services provided at the contractor’s place of business shall be based on Medicaid plus rates, and adjusted to ensure that the VAMC only pays for services provided.

VA acknowledges that, depending on the availability of resources at specific Indefinite-Delivery, Indefinite-Quantity (IDIQ) holder facilities at specific times, acceptance of a referral may be commercially impracticable for the IDIQ holder. In that event, the IDIQ holder may decline to accept an authorization. If the IDIQ holder has determined that space is not available and will not accept the Veteran, the Community Nursing Home program personnel will seek another IDIQ contract and an authorization will be issued when a match is found. Designated CNH program personnel will issue written authorizations for Veterans to the IDIQ holder. In accordance with FAR 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 IDIQ holders or other vendors would result in unacceptable delays in fulfilling that need. Location primarily will be selected based on the Veteran’s needs and proximity to the Veteran’s home.

PRICING INSTRUCTIONS: Pricing is based on Medicaid rates. A copy of the Medicaid rate for the Offeror’s facility must be provided on a State’s letterhead with the proposal.

Reduced Physical, Behavior & Cognitive Performance $ 000.00

B.5 PERFORMANCE WORK STATEMENT

36C24818R0308

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A. PERFORMANCE WORK STATEMENT OVERVIEW:

1. Federal Acquisition Regulation (FAR) – Indefinite Delivery Contracts (IDCs). In accordance with FAR 16.504, Indefinite-Quantity Contracts, this is an Fixed-Price, IDIQ with EPA for the time period. The Award Date for one (1) base year with four (4) options 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 CNH, if and when requested by the VA Contracting Officer or authorized representative, the Contractor shall furnish all supplies and services herein described, at the per diem rates for the “Levels of Care” specified in the Schedule of Items of this IDIQ. VA is obligated only to the extent authorized placement of patients is made in accordance with this IDIQ.

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

3. Policies and Regulations: The contractor is required to meet VHA performance and quality criteria and standards. Performance and quality standards may change during the course of the contract. New or revised quality/performance criteria or standards will be provided to the Contractor before implementation date. Compliance with mandated performance is required as a condition of this contract. Contractor shall comply with all relevant VA policies and procedures, including those related to quality, patient safety, and performance; including, but not limited to, the following:

a. 5 Code of Federal Regulations (C.F.R.) Part 1315:

https://www.gpo.gov/fdsys/granule/CFR-2002-title5-vol3/CFR-2002-title5-vol3-part1315

b. 42 C.F.R. Part 483 - Requirements for States and Long-Term Care Facilities: https://www.gpo.gov/fdsys/pkg/CFR-2017-title42-vol5/xml/CFR-2017-title42-vol5-part483.xml#seqnum483.1

c. 42 C.F.R. Part 409 - Hospital Insurance Benefits:

https://www.gpo.gov/fdsys/pkg/CFR-2017-title42-vol2/xml/CFR-2017-title42-vol2-part409.xml

d. 45 C.F.R. Part 160 - General Administrative Requirements:

https://www.ecfr.gov/cgi-bin/text-idx?tpl=/ecfrbrowse/Title45/45cfr160_main_02.tpl

e. 45 C.F.R. Part 162 - Administrative Requirements https://www.ecfr.gov/cgi-bin/text-idx?tpl=/ecfrbrowse/Title45/45cfr162_main_02.tpl

f. 45 C.F.R. Part 164 - Security and Privacy https://www.ecfr.gov/cgi-bin/text-idx?tpl=/ecfrbrowse/Title45/45cfr164_main_02.tpl

g. 5 United States Code (U.S.C.) 552 - The Freedom of Information Act:

https://www.justice.gov/oip/blog/foia-update-freedom-information-act-5-usc-sect-552-amended-public-law-no-104-231-110-stat

h. 10 U.S.C. 2409 - Contractor Employees: Protection from Reprisal for Disclosure of Certain Information:

https://www.gpo.gov/fdsys/granule/USCODE-2010-title10/USCODE-2010-title10-subtitleA-partIV-chap141-sec2409/content-detail.html

i. 18 U.S.C. 431 - Contracts by Member of Congress:

https://www.gpo.gov/fdsys/search/pagedetails.action?sr=5&originalSearch=&st=sets&ps=10&na=&se=&sb=re&timeFrame=&dateBrowse=&govAuthBrowse=&collection=&historical=false&packageId=USCODE-2015-title18&fromState=&bread=true&granuleId=USCODE-2015-title18-partI-chap23-sec431&collectionCode=USCODE&browsePath=Title+18%2FPart+I%2FChapter+23%2FSec.+431&collapse=true&fromBrowse=true

j. 31 U.S.C. 1341 - Limitations on Expending and Obligating Amounts:

https://www.gpo.gov/fdsys/granule/USCODE-2011-title31/USCODE-2011-title31-subtitleII-chap13-subchapIII-sec1341

k. 31 U.S.C. 1352 - Limitation on use of Appropriated Funds to Influence Certain Federal Contracting and Financial Transactions:

https://www.gpo.gov/fdsys/granule/USCODE-2010-title31/USCODE-2010-title31-subtitleII-chap13-subchapIII-sec1352/content-detail.html

l. 31 U.S.C. 3727 - Assignments of Claims:

https://www.gpo.gov/fdsys/granule/USCODE-2011-title31/USCODE-2011-title31-subtitleIII-chap37-subchapIII-sec3727/content-detail.html

m. 38 U.S.C. 1720 - Transfers for Nursing Home Care; Adult Day Health Care https://www.gpo.gov/fdsys/granule/USCODE-2011-title38/USCODE-2011-title38-partII-chap17-subchapII-sec1720

n. 38 U.S.C. 5705 - Confidentiality of Medical Quality-Assurance Records:

https://www.gpo.gov/fdsys/granule/USCODE-2010-title38/USCODE-2010-title38-partIV-chap57-subchapI-sec5705/content-detail.html

o. 38 U.S.C. 3903 - Limitations on Assistance; Special Training Courses https://www.gpo.gov/fdsys/granule/USCODE-2011-title38/USCODE-2011-title38-partIII-chap39-sec3903

p. 40 U.S.C. 37 - Contract Work Hours and Safety Standards:

https://www.gpo.gov/fdsys/granule/USCODE-2011-title40/USCODE-2011-title40-subtitleII-partA-chap37

q. 41 U.S.C. 21 - Restrictions on Obtaining and Disclosing Certain Information:

https://www.gpo.gov/fdsys/granule/USCODE-2011-title41/USCODE-2011-title41-subtitleI-divsnB-chap21

r. 41 U.S.C. 71- Contract Disputes:

https://www.gpo.gov/fdsys/granule/USCODE-2011-title41/USCODE-2011-title41-subtitleIII-chap71/content-detail.html

s. 41 U.S.C. 87 - Kickbacks:

https://www.gpo.gov/fdsys/granule/USCODE-2011-title41/USCODE-2011-title41-subtitleIV-chap87/content-detail.html

t. 41 U.S.C. 4712 - Pilot Program for Enhancement of Contractor Protection from Reprisal for Disclosure of Certain Information:

https://www.gpo.gov/fdsys/granule/USCODE-2012-title41/USCODE-2012-title41-subtitleI-divsnC-chap47-sec4712

u. 49 U.S.C. 40118 - Government Financed Air Transportation:

https://www.gpo.gov/fdsys/granule/USCODE-2011-title49/USCODE-2011-title49-subtitleVII-partA-subparti-chap401-sec40118/content-detail.html

v. VHA Handbook 1143.2 - VHA Community Nursing Home Oversight Procedures: http://www.va.gov/vhapublications/publications.cfm?pub=2

w. VHA Handbook 1100.17 - National Practitioner Data Bank Reports: http://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=2135

x. Health Insurance Portability and Accountability Act of 1996 (HIPAA):

http://www.cms.gov/Regulations-and-Guidance/HIPAA-Administrative- Simplification/HIPAAGenInfo/downloads/hipaalaw.pdf

y. VHA Handbook 1100.18 - Reporting and Responding to State Licensing Boards: http://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=1364

z. VHA Handbook 1605.1 - Privacy and Release of Information: http://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=142

aa. VHA Handbook 1907.01 - Health Information Management and Health Records: http://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=2791

ab. VHA Directive 2006-041 “Veterans’ Health Care Service Standards” (expired but still in effect pending revision): https://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=1443

ac. VHA Directive 2009-038: VHA National Dual Care Policy http://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=2058

ad. Health Insurance Portability and Accountability Act of 1996 (HIPAA):

http://www.cms.gov/Regulations-and-Guidance/HIPAA-Administrative- Simplification/HIPAAGenInfo/downloads/hipaalaw.pdf

ae. Patient Self Determination Act of 1991: http://www.gpo.gov/fdsys/search/pagedetails.action?st=citation%3A42+USC+1395dd&gr anuleId=USCODE-2010-title42-chap7-subchapXVIII-partE- sec1395cc&packageId=USCODE-2010-title42&bread=true

af. Privacy Act of 1974 (5 U.S.C. 552a) as amended:

http://www.justice.gov/oip/foia_updates/Vol_XVII_4/page2.hHm

ag. VA Publications: https://www.va.gov/vapubs/

ah. VHA Publications: https://www.va.gov/vhapublications/publications.cfm?pub=2

4. Definitions and Acronyms: Terms used in this contract shall be interpreted as follows unless the context expressly requires a different construction and/or interpretation. In case of a conflict in language between the definitions and other sections of this contract, the language in this section shall govern.

· AHCA: Agency for Health Care Administration

· AMA: Against Medical Advice

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

· Authorization: Authorizations for nursing home care will be accomplished on VA Form 10-7078, Authorization and Invoice for Medical and Hospital Services. Each authorization validity period will be from the initial effective date to disposition. Any extension to the original authorization validity period, regardless of the number of days, requires a new VA Form 10-7078.

· BAA: Business Associate Agreement

· CAPs: Corrective Action Plans

· CDC: Centers for Disease Control and Prevention

· CFR: Code of Federal Regulations

· CLIN: Contract Line Item Number

· CMS: Centers for Medicare & Medicaid Services

· CNH: Community Nursing Home

· COMM: Communications

· Contracting Officer(CO): The person executing this contract on behalf of the Government with the authority to enter into and administer contracts and make related determinations and findings.

· Contracting Officer’s Representative (COR): A person appointed by the CO to take necessary action to ensure the Contractor performs in accordance with and adheres to the specifications contained in the contract and to protect the interest of the Government. The COR shall report to the CO promptly any indication of non-compliance in order that appropriate action can be taken.

· COS: Chief of Staff

· CPARS: Contractor Performance Assessment Reporting System

· DEA: Drug Enforcement Agency

· DSN: Defense Switch Network

· EDI: Electronic Data Interchange

· EPA: Economic Price Adjustment

· EIN: Employer Identification Number

· FAPIIS: federal awardee performance and integrity information system

· ESRS: Electronic Subcontracting Reporting System

· Estimated: The quantities or dollar threshold listed are estimates only, and are not purchased by this contract. Except as this contract may otherwise provide, if the VA’s requirements do not result in orders in the quantities of dollar amount described, that fact shall not constitute the basis for an equitable price adjustment.

· FAPIIS: federal awardee performance and integrity information system

· FAR: Federal Acquisition Regulation

· FSC: Financial Service Center

· HHS: Department of Health and Human Services

· HIPAA: Health Insurance Portability and Accountability Act

· IAW: In Accordance With

· ID: Identification

· IDC: Indefinite Delivery Contract

· IDIQ: Indefinite Delivery-Indefinite Quantity

· IL: Information Letter

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

· ISO: Information Security Officer

· LD: Leadership

· LOA: Leave of Absence

· MD: Medical Doctor

· National Provider Identifier (NPI): NPI is a standard, unique ten (10)-digit numeric identifier required by HIPAA. The Veterans Health Administration must use NPIs in all HIPAA-standard electronic transactions for individual (health care practitioners) and organizational entities (medical centers).

· NICE: National Institute for Health and Care Excellence

· NFPA: National Fire Protection Association

· Not To Exceed (NTE): Contractor shall not exceed estimated quantities or dollar threshold without the express or written consent of the Contracting Officer. Adjustment made without approval will be considered an Unauthorized Commitment; violation under Federal Acquisition Regulation, FAR 1.602-3.

· OBRA: Omnibus Budget Reconciliation Act

· OIG: Office of Inspector General

· OSHA: Occupational Safety of Health Administration

· PI: Performance Improvement

· PPIRS: Past Performance Information Retrieval System

· PWS: Performance Work Statement

· Privileging (Clinical Privileging): Privileging is the process by which a practitioner, licensed for independent practice; e.g., without supervision, direction, required sponsor, preceptor, mandatory collaboration, etc.; is permitted by law and the facility to practice independently, to provide specific medical or other patient care services within the scope of the individual’s license, based upon the individual’s clinical competence as determined by peer references, professional experience, health status, education, training and licensure. Clinical privileges must be facility-specific and provider-specific.

· QA: Quality Assurance

· QASP: Quality Assurance Surveillance Plan

· QI: Quality Improvement

· RFP: Request for Proposal

· RI: Rights and Responsibilities

· RUG: Resource Utilization Group

· SAM: System for Award Management

· SF: Standard Form

· SMA: State Medicaid Agency

· TBD: To Be Determined

· Termination of Services: VA reserves the right to remove any or all VA patients from the nursing home at any time, when it is determined to be in the best interest of VA or the patients.

· TIN: Tax Identification Number

· U.S.: United States

· U.S.C: United States Code

· VA: Veterans Affairs

· VAAR: Veterans Affairs Acquisition Regulation

· Veterans Affairs Medical Center (VAMC): The Veterans Health Administration is the component of the United States Department of Veterans Affairs (VA) led by the Under Secretary of Veterans Affairs for Health that implements the medical assistance program of the VA through the administration and operation of numerous VAMC’s, Outpatient Clinics, Community Based Outpatient Clinics, and VA Community Living Centers (VA Nursing Home) Programs.

· Veterans Health Administration (VHA): The central office for administration of the VA medical centers throughout the United States. The VHA is in Washington, D.C.

· VISN: Veterans Integrated Service Network

B. REQUIREMENTS:

1. General: Nursing home facilities in the CNH program shall ensure that care meets the health needs and promotes the maximum well-being of VA patients. Nursing home care will be furnished to ensure the total medical, nursing, and psychosocial needs of VA beneficiaries. All nursing home facilities in VA’s CNH program must have current Center for Medicare and Medicaid Services (CMS) certification (Medicare and/or Medicaid) and a State nursing home license. VA developed quality of care standards utilizing CMS inspection criteria that are followed by VA in its selection of nursing homes which includes exclusionary criteria on which the CNH is evaluated. See VHA Handbook 1143.2, “VHA Community Nursing Home Oversight Procedures (June 4, 2004) a copy of which is available at: http://www.va.gov/vhapublications/publications.cfm?pub=2. VA often has a particular need for specialty care services in the CNH program. The VA requires CNHs to have a 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 and as determined by State guidelines. Laboratory, x-ray, and other special services will be available to VA patients as needed. In addition, the care provided will include room, meals, nursing care, and other services or supplies commensurate with the VA-authorized level of care, without extra charge. Duly authorized representatives of VA will provide quality oversight visits to veterans placed to assure continuity of care and to assist in the veterans’ transition back into the community. These visits do not substitute nor relieve the CNH in any way of the responsibility for the daily care and medical treatment of the veteran. The per diem rate(s) established in this IDIQ will include the cost of primary medical care, one (1) provider visit per month and needed consultation, 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: VA reserves the right to remove any or all VA patients from the CNH at any time when it is determined to be in the best interest of VA or the patients without additional costs to the Government.

3. Medicare/Medicaid Standards (QASP Indicator #1): The contractor is required to follow Medicare/Medicaid standards for all VA placements, except Life Safety. Medicare/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. Ancillary Costs: Ancillary costs are pre-approved costs for supplies or services not identified as included in the all-inclusive rate or any other pre- authorized rate or schedule or payment for items or services provided under this agreement. Ancillary costs such as medications, and special equipment, may not be added to any invoice without written permission of the VA medical center placing the veteran. If permission is received, the nursing home must also submit the physician's order for the medication/supply, the dispensing log, the supplier and the cost charged by the supplier to the nursing home, and what the nursing home is charging the VA.

6. Medicaid-Based Rates: The current State Medicaid rates may be used as a basis for determination of VA rates. The VA rate will include medical care, 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 Medicare, a description of the RUG-IV systems can be found in 42 CFR Parts 409, et al.

7. Primary Medical Coverage (QASP Indicator #2): The assigned CNH provider is the primary medical provider during the nursing home stay and is responsible for writing or approving admission and all other orders as soon as the veteran arrives at the CNH. The CNH provider is responsible for general medical care, urgent evaluation and intervention. Provider visits will be according to the Center for Medicare and Medicaid Services (CMS) guidelines. The assigned nursing home provider shall 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 Omnibus Budget Reconciliation Act (OBRA) guidelines (42 CFR 483.40, OBRA Guidelines).

8. Rehabilitation Criteria (QASP Indicator #3): 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. Medical Restorative criteria will be used for physical therapy, occupational therapy, and speech therapy. Therapy must be skilled, relate to safety and be restorative according to Medicare criteria.

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

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

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

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

11. State Licensure; Access to CNH Quality of Care Reports (QASP Indicator #4): The CNH shall maintain a current and unrestricted state license to operate as a skilled nursing facility. Changes in the status of the licensure shall be reported within 24-hours to: (TBD) CNH Program at: (TBD). 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 will make all final determinations as to the Contractor’s reasonable cooperation with VA and compliance with these requirements.

12. Corrective Action Plan (QASP Indicator #5): The CNH shall cooperate with timely development of Corrective Action Plans (CAPs) related to identified deficiencies and related to State, Federal or VA surveys. The CNH shall 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 in accordance with the Agency for Health Care Administration (AHCA) guidelines, however, not to exceed 30 days. The CNH shall 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 shall correct the deficiency as it relates to the individual;

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

c. Include the measures the CNH shall 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 shall develop a quality assurance tool for ensuring that correction is achieved and sustained. This tool must be implemented. Failure to implement a quality assurance tool to sustain compliance will reflect that the CNH has an ineffective quality assurance system; and

e. Provide dates when corrective action will be completed.

13. Life Safety Code (QASP Indicator #6): 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 fully-automatic sprinkler system installed in accordance with the National Fire Protection Association’s (NFPA) standards and be 100% sprinkled;

c. Natural disasters: The contractor shall provide an annual disaster plan providing a general outline on how evacuation procedures will be accomplished and a more detailed disaster plan when a notification of an imminent disaster has been received. The disaster plan 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.

14. Acceptable Safety and Sanitation Practices (QASP Indicator #7): Acceptable safety and sanitation practices shall be observed throughout the facility. The CNH shall address employee and patient safety practices through staff orientation, training and adherence to related policy or procedures to provide a safe and clean environment.

15. Re-admission to the VA Hospital and Emergency Care; Notification of Death of Veterans; CNH Responsibility to Veteran’s Belongings or Personal Effects (QASP Indicator #8): VA beneficiaries who begin to require more than the level of care authorized by VA will be readmitted to an appropriate VA facility, as determined and authorized by VA.

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

b. In the event of a death of any veteran, the Contractor agrees to notify VA within 24-hours of the death. In the event a death of a VA beneficiary while receiving nursing home care under this IDIQ, the CNH shall 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 shall forward an inventory of any such property and funds in its possession to the VA facility authorizing admission and will hold them (except articles of clothing necessary for proper burial) under safeguard until instructions are received from VA concerning disposition. CMS regulations require retention of records for five (5) years when there is no requirement in State law.

16. Leave of Absence (LOA) – Bed-Hold Statement: For re-hospitalizations or therapeutic passes, VA will pay a bed hold. Therapeutic passes will be authorized by the CNH staff based on individual patient needs, but are generally limited to two (2) times per month and should be pre-approved. VA will cover bed holds based on the following plan:

a. Bed holds for hospitalizations for long term veterans will follow Medicaid State guidelines;

b. There will be no bed-holds for short term, rehab veterans as per Medicare guidelines.

Bed-hold will begin the date the resident leaves the CNH and full per diem will resume on the date of readmission to the CNH. Absences of fifteen (15) consecutive calendar days or more, whether in a VA or in a non-Federal facility require a new authorization agreement.