36C24924R0066_2.docx

36C24924R0066

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. SIGNAT

URE 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

36C24924R0066 06-24-2024 Melvin Cole 615-225-5630 06-23-2025

10:00 AM

CDT

Department of Veterans Affairs Network Contracting Office 9 (90C) c/o, Melvin Cole, Contract Specialist 1639 Medical Center Parkway, Suite 204 Murfreesboro TN 37129 X 623110 N/A X Department of Veterans Affairs Lexington VA Medical Center 1101 Veterans Dr.

c/o: Jennifer Smith, Social Worker Lexington, TN 40502 90C Network Contracting Office 9 Department of Veterans Affairs c/o, Melvin Cole, Contract Specialist 1639 Medical Center Parkway Suite 204 Murfreesboro TN 37129

90C FSC e-Invoicing Payment http://www.fsc.va.gov/fsc/einvoice.asp Invoice Setup Information 1-877-489-6135 Invoice must be submitted electronically

Setup 1-877-489-6135 Veterans Integrated Service Network (VISN) 9, by way of Network Contracting Office (9) has an open and continuous requirement for Community Nursing Home (CNH) services in the Lexington, Kentucky area as specified in this solicitation document. Specialized services provided by nursing homes at a variety of care levels appropriate to individual patient needs is required. The service require-ments for CNH includes but is not limited to ancillary supplies, services, and and medications consistent with Centers for Medicare and Medicaid Services (CMS) require-ments, adhering to licensure, staffing, safety and quality measures.

See Price Schedule on page 10 of this document, the Statement of Work (SOW) for Community Nursing Homes on page 11 instructions for the preparation of proposals on page 54 , the clauses and provisions contained herein, attachments D.1:

RUG IV Descriptions, D.2: VHA-10-7078 Authorization Form, D.3: Application VHA-10-1170 RUG IV, D.4: DOL Wage Determination; and D.5: Contract Discrepancy Report.

$0.00 X X X Angela Tucker Contracting Officer Table of Contents

SECTION B - CONTINUATION OF SF 1449 BLOCKS

B.1 CONTRACT ADMINISTRATION DATA

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

1.1.1. CONTRACTOR:

Company Name:

Contact Person:

Title:

Address:

City/State/Zip:

Phone E-Mail:

COUNTY:

Tax ID No.:

UEID No.:

1.1.2. GOVERNMENT:

Contracting Officer’s Representative (COR) – provided upon award.

1.2. CONTRACTOR REMITTANCE ADDRESS: All payments by the Government to the contractor will be made in accordance with FAR 52.232-33, Payment by Electronic Funds Transfer-System for Award Management.

1.3. SYSTEM FOR AWARD MANAGEMENT (SAM): Federal Acquisition Regulations require that federal contractors register in the System for Award Management (SAM) database at http://www.sam.gov and enter all mandatory information into the system. Award will be made to a Contractor who has completed this registration prior to award. Offerors are encouraged to ensure that they are registered in SAM prior to submitting their offer.

1.4. ONLINE REPRESENTATIONS AND CERTIFICATIONS APPLICATION (ORCA): Federal Acquisition Regulations (FAR 4.1201) require that federal contractors register in the Online Representations and Certifications at http://sam.gov and enter all mandatory information into the system; and the SAM registrations must be kept current and updated at least annually. Award will not be made until Contractor has completed registration in SAM.

1.5. CONTRACT TERM: The contract terms for an ordering period of up to five years beginning the effective date of this contract, and it includes up to four (4) one-year option periods. This contract also includes Federal Acquisition Regulation (FAR) clause 52.217-8 for a possible extension of up to six (6) months at the discretion of the Government.

B.2 RATE DETERMINATION

2.1. Medicare-Based Rates. VA will utilize the appropriate Resource Utilization Grouping (RUG) rate(s) as a guide to determine VA rates. The VA RUG rate will include the cost of medical care, routine medications, laboratory, x-ray, therapy(ies), and other special services authorized by VA, unless otherwise specifically exempted (refer to Table A in the schedule items). VA will contract for appropriate Medicare categories of care using Resource Utilization Groups (RUGs-IV) as a reference (See attachment D.1.). A description of the RUGs-IV systems can be found in 42 CFR Parts 409, et al. and Attachment D.1. Levels of Care classifications to be used in this contract include: Rehabilitation Plus Extensive Services; Rehabilitation; Extensive Services; Special Care High; Special Care Low; Clinically Complex; Behavioral Symptoms and Cognitive Performance; and Reduced Physical Function.

2.1.1. Level of Care Classification: The Level of Care classification and associated per diem rates will remain in effect for each placement until and unless one of the following events takes place:

2.1.1.1. Re-hospitalization that may be associated with a change in level of care;

2.1.1.2. Need for more intensive therapy;

2.1.1.3. Significant change in condition; or

2.1.1.4. Classification changes may also occur based on a determination by VA. The VA will issue a new authorization accordingly.

2.1.2. Medicare Rates. The per diem rate will be established by utilizing the current Medicare rate set by the Centers for Medicare and Medicaid Services (CMS) including the cost of supplies, services, and equipment above that which is provided under Medicare. Medicare 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.

2.1.3. Medicare Rate Determination: The VA is seeking preferred rates based on patient care need. VA rates are an all-inclusive per diem rate. Items generally included or excluded in the per diem rate are listed in Table A, although some variances may apply in coverage. The per diem rate(s) will apply throughout the term of this IDIQ contract.

NOTE: During the term of this contract, Medicare payment method for Skilled Nursing Facility (SNF) MAY change to the Patient Driven Payment Model (PDPM) or another system. However, until further notice, VA pricing will be based on rates published in the Federal Register. These rates may be increased or decreased annually based on the market and as determined by Centers for Medicare and Medicaid Services (CMS) and the VA.

2.1.4. Rate Adjustments: Rate adjustments are made at the request of the Contractor and shall be made in accordance with the proper Federal regulatory standard and in accordance with the IDIQ as mutually agreed upon by both parties. Rate adjustments are not effective until the IDIQ modification is signed by both the Contractor and the VA Contracting Officer. The effective date of the rate adjustment will be the first day of the month following the date the Contractor and the VA sign the modification. Throughout the term of the contract, the VA will adjust the Medicare Base Rate at the request of the Contractor in accordance with the EPA clause incorporated into the contract (VAAR Clause 852.216-71). CMS Website link: https://www.cms.gov

2.1.5. The CNH’s Minimum Data Set (MDS) Assessment for Medicare: The CNH’s Minimum Data Set (MDS) assessment will be completed on the same schedule as the current Medicare MDS-Scheduled assessments, including close of therapy (COT) assessments. Classification changes will be approved by VA, dependent on projection for short-term or long-term residence, and adhering to the most current MDS frequency guidelines from Medicare. The applicable per diem rate will continue until the next assessment. VA will make the determination whether classification changes require readmission to VA. VA staff will audit approximately 20% of the MDS assessments.

2.2. 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 contract. 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 VAMC may request the nursing home 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. Special equipment, e.g., Clinitron bed, are not considered routine ancillary services items such as this may be provided by the VA or may be included via a bilateral modification.

2.3. Minimum and Maximum Amounts for this IDIQ Contract: The total contract minimum spend on this contract is one day of per diem at the lowest RUG IV Level of Care. The total contract maximum amount for this contract is $10 million.

2.4. Economic Price Adjustment: Medicare pricing changes by law annually. At contractor’s request, rate adjustments shall be processed by bilateral modification to the contract. The effective date for rate adjustments shall be the first day of the month following Contractor and Contracting Officer signing the modification document.

2.4.1. This provision does not apply to ancillary services that may be added or deleted from the Agreement.

2.4.2. The per diem rate(s) will apply throughout the term of this contract, including extension period(s). The rate(s) may be adjusted only to reflect a change in a Medicare rate as authorized by CMS. Normally, this will be on an annual basis. The negotiated percentage of the Medicare rate shall be an all-inclusive rate given the all-inclusive nature of the contract, and the percentage will not be renegotiated; but will be applied and added to the new Medicare rate for the adjusted per diem rate for each level of care item. Each per diem price adjustment under this clause is subject to the following limitations:

2.4.2.1. Any adjustment shall be limited to the effect of increases or decreases in the approved CMS patient care components within the affected Medicare groups.

2.4.2.2. Adjustments will occur no more frequently than those issued by CMS.

2.4.2.3. No adjustments will be made until the Contracting Officer receives a written request from the CNH administrator or other authorized nursing home official. The Contracting Officer shall process the adjustment request within fourteen (14) days of receipt. Any adjustment shall be made effective the first day of the month following receipt of the written request for an adjustment so long as the request is received by the Contracting Officer at least fourteen (14) days prior to the end of the month. A copy of the fully executed document will be sent to the requesting nursing home official for record keeping purposes.

2.4.3. The CO should establish multi-level care rates wherever possible regardless of whether the local state has only a unitary care rate program, as the multi-level care rate approach can better approximate the actual cost of care for individual patients. The levels of care can be either the VA version (use also for private care CNHs) as shown on the CMS Website for the state and county in which CNH services are provided. All levels of care required for the contract period, including the option period(s), should be listed whenever possible. This will eliminate or minimize the need for modifications. A list of VA levels of care is contained in the Sample Price Schedule shown in the Description of Care column below. Definitions of the VA levels of care displayed on the CMS Website are listed as Attachment 1 as referenced in Section E of this format. Attachment 1 should be included when VA levels of care are included.

2.5. Medications: All medications administered to VA-contracted Veterans residing in a CNH will be charged according to Average Warehouse Price (AWP) plus a 3% transaction fee, or actual Pharmacy bill, whichever the VA deems most appropriate. Medication costs up to 8.5% of billed care are included in the RUG rate pricing. Medication costs which exceed 8.5% of the monthly per diem will be billed as a separate line item in addition to the applicable RUG rate(s). All calculations will be made on a monthly basis. When a patient’s medication costs are determined to be in excess of 8.5%, the VA must be promptly alerted to establish an appropriate course of action. This course of action may include the VA providing medication(s) to the CNH for the contracted Veteran or requiring an acceptable alternative medication be substituted. The VA also reserves the right to deny payment for medication, which at its sole discretion, is determined by the VA to be of no clinical benefit to the Veteran.

TABLE A

Minimum of 1 visit per month unless Rate requires more frequent visits. Pre-approval required for any additional for charge visits.

Non-Routine/Specialized Durable Medical Equipment

Specialized Beds

Hospice Care

Dialysis

Transportation

Urgent Care (UC) / Emergency Room (ER) Visits

Hospitalizations

Dental Care

Audiology Care

Eye Care

Custom Prosthetics

See SOW paragraphs 3.7.3. and 3.24.

See SOW paragraphs 2.1.2. and 3.7.3.

B.3 PRICE SCHEDULE

Medicare RUGS IV Pricing Schedule

ES3 – Extensive Services – ADL 2-16

HE2 – Special Care High – ADL 15-16

LE2 – Special Care Low – ADL 15-16

CE2 – Clinically Complex – ADL 15-16

BB2 – Behavior Symptoms – ADL 2-5

NOTE: Percentage of Medicare rates are negotiated at contract award. These rates shall not be adjusted during the term of the contract. Medicare base rates will change when and if rates are adjusted by CMS.

B.4 STATEMENT OF WORK

3.1. OVERVIEW

3.1.1. Federal Acquisition Regulation (FAR) – Indefinite Delivery Indefinite Quantity Contract (IDIQ). In accordance with FAR 16.504, Indefinite-Quantity Contracts, this is an IDIQ contract with an ordering period of up to five years beginning from the date of award and it includes up to four (4) one-year option periods. This contract also contains an up to 6-month option to extend at the sole discretion of the Government. This requirement is being solicited under the authority of 38 U.S.C. 8153 and FAR Part 12 and VAAR Part 873.

3.1.2. 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 Ordering Officer when delegated, 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, Attachment D.1., RUGs IV Levels of Care, of the solicitation and the IDIQ. VA is obligated only to the extent authorized if placement of patients is made in accordance with the terms specified in the IDIQ.

3.1.3. Ordering. Orders may be issued by Ordering Officers to place Veterans in Nursing Homes utilizing the CPRS system at VA hospital sites (Reference FAR 16.505(b)(2)(i)(B)). Ordering Officer Contact information is as follows:

Ordering Officer Name:

E-mail address

Ordering Officer Name:

E-mail address

3.1.3.1. Orders will be placed without utilizing the fair opportunity process. Orders are subject to the relevant exceptions to the fair opportunity process.

3.1.3.2. The VA Ombudsman for task orders is the Associate Deputy Assistant Secretary (ADAS) for Procurement Policy, Systems, and Oversight (PPSO). The address and e-mail address for the Ombudsman is as follows:

Department of Veterans Affairs ADAS for Procurement Policy, Systems, and Oversight Risk Management and Compliance Service 810 Vermont Avenue, NW Washington, DC 20420 VARiskManagement@va.gov

3.1.4. Referrals to Community Nursing Homes (CNHs) and Placements. VA acknowledges that, depending on the availability of resources at specific IDIQ holder facilities at specific times, acceptance of a referral may be commercially impracticable for the IDIQ holder. Commercial or situational impracticability (e.g. facilities must be able to perform pre-admission screenings; assess whether the nursing home has beds open and appropriate beds; are not able to meet care needs based on number of staff and possess the clinical expertise to manage veterans care; have the appropriate room (private or shared); can manage certain behaviors (like wandering if they don’t have a secure unit); and have the ability to decline based on criminal records, etc.). 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 CNH program personnel will seek another IDIQ contract and an authorization will be issued when a match is found.

3.1.4.1. Designated CNH program personnel will issue written authorizations for Veterans to the IDIQ holder. In accordance with FAR 16.505(b)(2)(i)(A) or FAR 16.505(b)(2)(i)(B), VA has determined it is in the best interest of the Veteran to place the individual order without further competition because the need for these services is sometimes urgent, and providing the opportunity to all 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.

3.2. 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 appropriate U.S. Department of Veterans Affairs (VA) Medical Center (VAMC) Health Care System outlined in the table below at the prices specified in the section titled Schedule of Items of this IDIQ contract. 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 terms, “facilities” and “nursing home” shall include but not be limited to rooms, wards, sections, eating areas, drinking fountains, entrances, and other like areas.

3.3. Requirements

3.3.1. 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. The contractor is required to follow Medicare standards for all VA placements, except Life Safety. Medicare and Medicaid clinical and program standards are found in 42 CFR 483. All nursing home facilities in VA’s CNH program must have current Center for Medicare and Medicaid Services (CMS) certification and a state nursing home license (in the state where the CNH facility operates). VA often has a particular 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, but no later than 72 hours). Primary Care/Provider (medical doctor, nurse practitioner, and/or physician assistant) visits will be available at the Medicare frequency requirements, but not less than 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.

3.3.2. 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 and nursing care, room and board, meals, primary medical care which includes provider visit(s), drugs (except for medications that exceed 8.5% of the per diem rate on a monthly basis) 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).

3.3.3. The VA does not regulate the care provided or inspect CNH facilities. VA acts as an informed purchaser of care in order to purchase quality services for Veterans and enhance the Veterans’ experience in the home.

3.3.4. Full attention shall be given to motivating and educating Veteran patients to achieve and maintain independence in the activities of daily living. Each Veteran must receive, and the facility must provide, the necessary care and services to attain or maintain the highest practicable physical, mental, and psychosocial well-being, in accordance with comprehensive assessment and plan of care. Every effort shall be made to keep patients ambulatory and to achieve an optimal level of self-care.

3.3.5. The nursing home is responsible for supervising VA beneficiaries housed at the facility whether the beneficiary is at the facility or has been transported to a clinic or other outpatient treatment facility, physician’s office or the VAMC. The nursing home is responsible for complying with all rules, policies and regulations relating to providing 24-hour protective oversight of residents. If a veteran is sent to an outpatient appointment, the nursing home must make a judgement as to whether the veteran needs physical assistance due to disability or oversight due to confusion. The nursing home must assure that adequate oversight and assistance is provided during the outpatient appointment. This includes during time of transport to and from the nursing home. Oversight can be provided by a family member, clergy person, volunteer, or any other person, who, in the judgement of the nursing home, can responsibly and capably provide the necessary assistance and oversight. In the absence of any other person, the nursing home shall send a staff member to assure protective oversight.

3.3.6. Transportation to and from the VAMC hospital/clinic for outpatient appointments may be provided by the VA if the veteran meets current travel eligibility requirements. The VA does not insist that transportation be provided by the VA. Those veterans who have family or others capable of transporting and providing supervision to the veteran in the outpatient setting are encouraged to do so. If no other means are available, the VA will be responsive to requests by the nursing home for transportation.

3.3.6.1. If a veteran is sent to an outpatient appointment at the VA (or admission exam where admission is not a certainty) the nursing home must make a judgment as to whether the veteran needs physical assistance due to disability or oversight due to confusion. The nursing home must assure that adequate oversight is provided during the trip to the VA or while in the outpatient clinic. Oversight can be provided by a family member, clergy person, volunteer, or any other person who, in the judgment of the nursing home can responsibly and capably provide the necessary oversight. However, someone from the facility or a family member or volunteer must be with a resident who evidences any mental confusion or who would have a problem negotiating his/her way through the outpatient clinic process.

3.3.6.2. In the absence of any other person, the nursing facility should send a staff member to assure protective oversight. This judgment is made by the nursing home and does not preclude “dropping off” a mentally alert and physically capable resident for a medical appointment or some other activity, to be picked up at a later time.

3.3.7. When the veteran is in the outpatient clinic at the VA, s/he still is considered a resident of the nursing facility that is thereby responsible to provide physical assistance and protective oversight. The VA’s responsibility in the outpatient clinic is for treatment only.

3.4. 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.

3.5. VA Authorizations. Authorization for nursing home care will be issued to the facility per written VA authorization (or order) (the VA currently uses VA Form 10-7078). Each authorization validity period will be noted on the written authorization/order a beginning and end date. Any extension to the original authorization validity period, regardless of the number of days, requires a new authorization/order.

NOTE: During the term of this contract, the Medicare payment method outlined above in section B.2 Rate Determination may change to Patient Driven Patient Method (PDPM) or another system. See also, Price Schedule in Section B.3 of this contract.

3.6. Ordering Officers: Ordering Officers are to be used for this contract. Ordering Officers (OO) will be authorized to place orders against this contract. The Contracting Officer (CO) will furnish the Contractor with the names of individuals authorized as OO by separate memorandum upon issuance of the contract. When OOs are added after award, the CO will furnish the Contractor with the names of individuals authorized to be OOs by memorandum upon OO appointment. OOs are responsible for issuing and administering orders placed under this contract. OOs have no authority to modify any term of this basic contract. Any deviation from the terms of the basic contract must be approved in writing by the CO responsible for this contract. The Contractor shall accept orders against this contract only from the CO and/or authorized OO. Fulfilling orders from persons other than the CO or OO may result in loss or delay in payment for supplies/services provided under such orders.

3.7. Primary Medical Coverage. 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 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). For a listing of included and not included services within the per diem rate, please refer to Table A below.

3.7.1. Rehabilitation Therapy: Any type of rehabilitation therapy (physical therapy, occupational therapy, speech therapy, etc.) requires the pre-approval of the VA before the initiation of therapy. Rehabilitation therapies will be provided as a distinct level of care. Hospice Care and Dialysis are not included in the rate. VA or other payers may be used for Hospice and Dialysis, as determined by the Veteran with VA approval. Hospice and dialysis services may be added for a patient by bilateral modification.

3.7.2. Mental Health Care Services: Routine patient mental health care services, including provision of mental health prescriptions/medications, shall be provided as part of the contracted CNH primary care services.

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

3.7.4. Specialized Prosthetics Equipment: Veterans may be eligible for specialized equipment when clinically indicated. Pre-approval and separate authorization are required by VA.

3.7.5. Other Services Not Included in Per Diem Rates: Other services require separate pre-approval and separate authorization of the VA, if the CNH is qualified to provide these special services and based on individual Veteran need.

3.8. 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. 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.

3.8.1. 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.

3.8.2. 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.

3.9. Emergency Care; Financial Responsibility; Advanced Directives. If a VA patient is receiving care at a Community Nursing Home (CNH) pursuant to this agreement and that patient requires hospitalization due to an acute condition or an emergency, the CNH will immediately take steps necessary to either admit the patient to an appropriate VA Medical Center (VAMC), or to arrange for emergency transport to the nearest non-Federal emergency room as stated herein. At the onset of such a situation with a VA patient an employee at the CNH facility will immediately contact the appropriate VAMC Emergency Room and obtain instructions as follows:

3.9.1. If hospitalization of an emergent nature is required and the patient’s condition is critical the VAMC Emergency Room will either:

3.9.1.1. Arrange to transport the Patient to the VAMC Emergency Room, OR

3.9.1.2. The CNH will be instructed by the VAMC Emergency Room to contact 911 for ambulance transport to the closest, non-Federal hospital emergency room. It is agreed that readmission to a VA facility will be accomplished once the patient's condition is sufficiently stabilized to permit admission to VA.

3.9.2. If hospitalization of an emergent nature is required and the patient’s condition is so critical that there is not sufficient time to contact the VAMC Emergency Room, it is agreed that hospitalization in a non-Federal facility may be accomplished provided the VA is notified in accordance with this agreement; and VA notification must be made within 72 hours of the emergency admission of the patient to a non- Federal facility and notification shall be made via the Emergency Care Reporting portal at https://emergencycarereporting.communitycare.va.gov/#/request or calling 844-72HRVHA (844-724-7842).

3.10. Medical Records:

3.10.1. 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.

3.10.2. Veteran/Patient Records Requirements

3.10.2.1. Contractor shall comply with all applicable records management laws and regulations, as well as National Archives and Records Administration (NARA) records policies, including but not limited to the Federal Records Act (44 U.S.C. chs. 21, 29, 31, 33), NARA regulations at 36 CFR Chapter XII Subchapter B, and those policies associated with the safeguarding of records covered by the Privacy Act of 1974 (5 U.S.C. 552a). These policies include the preservation of all records, regardless of form or characteristics, mode of transmission, or state of completion.

3.10.2.2. In accordance with 36 CFR 1222.32, all data created for Government use and delivered to, or falling under the legal control of, the Government are Federal records subject to the provisions of 44 U.S.C. chapters 21, 29, 31, and 33, the Freedom of Information Act (FOIA) (5 U.S.C. 552), as amended, and the Privacy Act of 1974 (5 U.S.C. 552a), as amended and must be managed and scheduled for disposition only as permitted by statute or regulation.

3.10.2.3. In accordance with 36 CFR 1222.32, Contractor shall maintain all records created for Government use or created in the course of performing the contract and/or delivered to, or under the legal control of the Government and must be managed in accordance with Federal law. Electronic records and associated metadata must be accompanied by sufficient technical documentation to permit understanding and use of the records and data.

3.10.2.4. The VA and its contractors are responsible for preventing the alienation or unauthorized destruction of records, including all forms of mutilation. Records may not be removed from the legal custody of the VA or destroyed except for in accordance with the provisions of the agency records schedules and with the written concurrence of the Head of the Contracting Activity. Willful and unlawful destruction, damage or alienation of Federal records is subject to the fines and penalties imposed by 18 U.S.C. 2701. In the event of any unlawful or accidental removal, defacing, alteration, or destruction of records, Contractor must report to the VA. The agency must report promptly to NARA in accordance with 36 CFR 1230.

3.10.2.5. The Contractor shall immediately notify the appropriate Contracting Officer upon discovery of any inadvertent or unauthorized disclosures of information, data, documentary materials, records, or equipment. Disclosure of non-public information is limited to authorized personnel with a need-to-know as described in the [contract vehicle]. The Contractor shall ensure that the appropriate personnel, administrative, technical, and physical safeguards are established to ensure the security and confidentiality of this information, data, documentary material, records and/or equipment is properly protected. The Contractor shall not remove material from Government facilities or systems, or facilities or systems operated or maintained on the Government’s behalf, without the express written permission of the Head of the Contracting Activity. When information, data, documentary material, records and/or equipment is no longer required, it shall be returned to the VA control, or the Contractor must hold it until otherwise directed. Items returned to the Government shall be hand carried, mailed, emailed, or securely electronically transmitted to the Contracting Officer or address prescribed in the Contract. Destruction of records is EXPRESSLY PROHIBITED unless in accordance with Paragraph (4).

3.10.2.6. The Contractor is required to obtain the Contracting Officer's approval prior to engaging in any contractual relationship (sub-contractor) in support of this contract requiring the disclosure of information, documentary material and/or records generated under, or relating to, contracts. The Contractor (and any sub-contractor) is required to abide by Government and the VA guidance for protecting sensitive, proprietary information, classified, and controlled unclassified information.

3.10.2.7. The Contractor shall only use Government IT equipment for purposes specifically tied to or authorized by the contract and in accordance with the VA policy.

3.10.2.8. The Contractor shall not create or maintain any records containing any non-public the VA information that are not specifically tied to or authorized by the contract.

3.10.2.9. The Contractor shall not retain, use, sell, or disseminate copies of any deliverable that contains information covered by the Privacy Act of 1974 or that which is generally protected from public disclosure by an exemption to the Freedom of Information Act.

3.10.2.10. The VA owns the rights to all data and records produced as part of this contract. All deliverables under the contract are the property of the U.S. Government for which the VA shall have unlimited rights to use, dispose of, or disclose such data contained therein as it determines to be in the public interest. Any Contractor rights in the data or deliverables must be identified as required by FAR 52.227-11 through FAR 52.227-20.

3.10.2.11. Training. All Contractor employees assigned to this contract who create, work with, or otherwise handle records are required to take the VA-provided records management training. The Contractor is responsible for confirming training has been completed according to agency policies, including initial training and any annual or refresher training. The VA reserves the right to add mandatory training programs, by mutual agreement of the parties, during the term of this contract.

3.10.2.12. The Contractor shall incorporate the substance of this clause, its terms and requirements including this paragraph, in all subcontracts under this Contract, and require written subcontractor acknowledgment of same.

3.10.2.13. Violation by a subcontractor of any provision set forth in this clause will be attributed to the Contractor.

3.11. Quality Expectations for CNH’s:

3.11.1. To participate in VA’s CNH Program, CNHs are expected to have either 1) a three-star overall rating, or 2) a two-star overall rating with a four star or greater quality measures score on the CMS Nursing Home Compare Web site (https://www.medicare.gov/nursinghomecompare/search.html).

3.11.2. CNHs with lower scores may participate in the CNH program only when specifically approved by the Assistant Under Secretary for Health for Operations, or designee, via a signed and approved waiver.

3.11.3. All CNHs in the CNH Program must be certified by CMS under Title XVIII (Medicare) or have received special approval from the Office of Geriatrics and Extended Care (GEC) Office. CNHs are responsible to the State of jurisdiction (where the CNH resides and provides services to Veterans) and CMS for the care provided. VA does not regulate the care or inspect CNHs. VA acts as an informed purchaser of care in order to purchase quality services for Veterans and enhance the Veterans’ experience in the home.

3.11.3.1. The CNH must maintain a current and unrestricted state license to operate as a skilled nursing facility in the state in which services are being provided. The CNH provider must maintain current liability insurance coverage as noted in Section C. A copy of the current unrestricted state license along with a copy of the current liability insurance declarations page must be forwarded to the VAMC and to the CO annually. Changes in the status of the licensure will be immediately reported to the VAMC Home and Community Care Department at the phone number listed below for the appropriate VAMC. 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 agency reports; on-site inspection of the CNH by VA staff; and/or on-site monitoring of Veterans. The CNH shall provide VA with copies of all State agency reports when requested and cooperate fully with VA’s quality improvement or quality assurance program functions, 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.

Lexington, KY 40511-1093 1-859-327-2270

3.11.3.2. The CNH shall cooperate fully with VA’s quality improvement or quality assurance program functions relating to this IDIQ. The VA Contracting Officer shall make all final determinations as to the Contractor’s reasonable cooperation with VA and compliance with these requirements.

3.12. Corrective Action Plan. The CNH will cooperate with timely development of Corrective Action Plans (CAPs) related to identified deficiencies and related to State, Federal or VA request. The CNH will develop in the time period specified by VA timely and appropriate CAPs for VA 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:

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

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

3.12.3. 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;

3.12.4. 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.