P03 HCA CHN J-A HCA APPROVED_4.pdf

HCA Approval for Justification for Other than Full & Open Competition – Nursing Home Care Services

DEPARTMENT OF VETERANS AFFAIRS

SOLE SOURCE JUSTIFICATION UNDER SIMPLIFIED PROCEDURES FOR CERTAIN COMMERCIAL

ITEMS IN ACCORDANCE WITH FAR 13.5

Acquisition Plan Action ID: See Attachment

1. Contracting Activity: Department of Veterans Affairs, Network Contracting Office (NCO) 12 Great Lakes Acquisition Center, 115 S. 84th Street, Suite 101, Milwaukee, Wisconsin 53214, on behalf of Veterans Integrated Services Network (VISN) 12 Medical Centers/Hospitals. This is a justification for Other than Full & Open Competition. The 1358 funding and payment process will be utilized.

2. Nature and/or Description of the Action Being Processed: This procurement is for multiple facilities providing Nursing Home Services in accordance with FAR 13.5 Simplified Procedures for Certain Commerical Items and specifically FAR 13.501 Special Documentation Requirements, where acquisitions conducted under Simplified Acquisition Procedures are exempt from the requirements of FAR Part 6. The Community Nursing Home (CNH) Services for review shall be awarded as 5-year ordering period follow-on fixed price (FP) with economic price adjustment (EPA) Indefinite Delivery Indefinite Quantity (IDIQ) contracts.

3. Description of Supplies/Services Required to Meet the Agency’s Needs: The Contractors are to provide nursing home care in accordance with the VHA Community Nursing Home Procedures specified in VHA Notice 2022-19, Dated December 27, 2022 (link to Notice: N202219_.pdf) Community Nursing Home Program. Nursing Homes provide a place where Veterans can live full time and receive skilled nursing care any time of day or night. The VA Medical Centers contract with community nursing homes within their vicinity to care for Veterans near their homes and families. Nursing homes are required to furnish the total medical, nursing, and psychosocial needs of VA beneficiaries.

All nursing homes facility(s) must have current Center of Medicare and Medicaid Services (CMS) certification (Medicare and/or Medicaid) and a State nursing home license.

The VA requires CNHs to have bed capacity to ensure their ability to take referrals when requested. The CNH also must be able to accept VA referrals in a timely fashion (ideally within 24 hours of request).

Provider visits must be provided at the rate of one 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.

The per diem rate(s) established in the IDIQ shall include the cost or primary medical care, one provider visit per month and needed consultation, a percentage of medications and routine supplies, laboratory, x-ray, and other special services authorized by VA, unless otherwise specifically excepted.

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.

Each IDIQ contract will have a five-year ordering period with an anticipated effective date as early as October 1, 2023 through September 30, 2028.

The estimated values of these procurements are attached.

4. Statutory Authority Permitting Restricted Competition:

FAR 13.5 Simplified Procedures for Certain Commercial Items. The statutory authority for applying the Simplified Procedures for Commercial Items of FAR 13.5 is 41 U.S.C. § 1901 and is implemented by FAR 13.106-1(b)(2) for restricting competition on this procurement. Competition is restricted on this procurement for the reason below:

( X ) Only One Responsible Source and No Other Supplies or Services Will Satisfy Agency Requirements

( ) Unusual and Compelling Urgency ( ) Industrial Mobilization, Engineering, Developmental or Research Capability or Expert

Services ( ) International Agreement ( ) Authorized or Required by Statute ( ) National Security ( ) Public Interest

5. Demonstration that the Contractor’s Unique Qualifications or Nature of the Acquisition Requires the Use of the Authority Cited Above: For more than 35 years the CNH Program has maintained two cornerstones: some level of patient choice in choosing a nursing home close to the Veteran’s home and family, and a unique approach to local oversight of CNHs consisting of annual reviews and monthly patient visits. The primary goal of the VA is to maintain or restore the Veterans to the highest-level well-being, while assisting Veterans and their families in making the transition from an episode nursing home care to the community, therefore; changing facilities at this time is not in the best interest to the Veterans. The current vendors are within the catchment area where the Veterans reside. Currently, there are numerous patients residing in the facilities and the facilities are located near the family and friends of the residents. Relocating the residents to different facilities outside of the catchment areas would cause an undue burden on their families due to increased travel time and costs associated with traveling to a facility outside of the catchment areas.

A search of Veteran Population - National Center for Veterans Analysis and Statistics (va.gov) shows that there are veterans located in the county of the medical centers/hospitals, as of September 30, 2021, which demonstrates a continual need for nursing home services to serve this population. In addition, a five-year contract would provide continual coverage for veterans.

6. Description of Efforts Made to ensure that offers are solicited from as many potential sources as deemed practicable: An Intent to Sole Source Notice was posted to the Contract Opportunities website (SAM.gov | Home) for each of the nursing home requests (see attachment). No responses were received.

7. Determination by the CO that the Anticipated Cost to the Government will be Fair and Reasonable:

The anticipated cost will be fair and reasonable based on the rates published by the Centers for Medicare and Medicaid Services (CMS) which are determined by law and regulation. The negotiated percentage to the State Medicare rate is expected to remain constant throughout the life of the contract and is changed only when State Medicare rates are adjusted and will be modified in accordance with the economic Price Adjustment clause when necessary.

8. Description of the Market Research Conducted and the Results, or a Statement of the Reasons Market Research Was Not Conducted: According to 38 USC 8153, Sharing of Health Care Resources, the VA’s “Rule of Two” does not apply to sole source awards. However, the Contracting Officer shall consider the impact and determine the best method of successfully implementing the Rule of Two requirement according to the Veterans First Contracting Program. Although there are several factors that support the sole source decision, one critical factor in the initial placement effort combined with the medical need and availability of the nursing home facility, is the Veteran’s choice in a nursing home facility is based on proximity to family and home.

Market Research is dependent on the needs of the patient and resources of the VA Medical Center. It is customarily performed by the VA Social Worker, CNH Review Team, Veteran and the Veterans family. This collaboration is necessary to maximize patient care needs. Substantial efforts are made to identify the top-quality facilities in the geographical area by communicating with networking professionals. The Program Office personnel query the Nursing Home Compare website (Find Healthcare Providers: Compare Care Near You | Medicare) to determine the availability of nursing homes in the subject area. In this case, it was determined that there were no other nursing homes in a geographically convenient area near the veteran’s family and friends.

9. Any Other Facts Supporting the Use of Other than Full and Open Competition: The nursing homes have been providing consistent care to veterans in these geographical areas for more than five years.

They employ many local people who have known many of their residents and families for many years.

They have been surveyed annually by the VAMC/Hospital Survey Teams. The CNH Coordinators have retained the survey reports for the facilities and have recommended continued contracting support from these nursing home.

Under the authority of 38 U.S.C. 8153 implemented in VAAR 873, it is the Contracting Officer’s determination to award a sole source single IDIQ contract for CNH services not to exceed $7.5M using simplified procedures using FAR Part 13.5. Acquisitions shall be conducted using the acquisition strategies at VAAR 873.111(a) Request for Quotations, and VAAR 873.111(d)(i) Alternative Negotiation Techniques, in conjunction with FAR Part 13.

Placing veterans in a new facility would not only be a physical, but mental hardship on the Veterans and their families.

10. Listing of Sources that Expressed, in Writing, an Interest in the Acquisition: See Section 6 above.

11. A Statement of the Actions, if any, the Agency May Take to Remove or Overcome any Barriers to

Competition before Making subsequent acquisitions for the supplies or services required: There are no barriers as CNH’s are sole sourced based on VA Medical Center needs for Veterans in catchment areas where the CNH meets the qualifications and oversight requirements stated in VHA Notice 2020- 32, Community Nursing Home Program, dated October 1, 2020.

Should additional providers be required in their catchment area, the VA Social Worker, CNH Review Team, Veteran and the Veteran’s family will collaborate to identify a facility that can meet the veteran’s patient care needs. The Program Office personnel will query the Nursing Home Compare website (Find Healthcare Providers: Compare Care Near You | Medicare) to determine the availability of suitable nursing homes in the subject area.

12. Requirements Certification: I certify that the requirement outlined in this justification is a Bona Fide Need of the Department of Veteran Affairs and that the supporting data under my cognizance, which are included in the justification, are accurate and complete to the best of my knowledge and belief.

Mandi Evanson Contracting Officer’s Representative Hines VA Hospital

13. Approvals in accordance with the VHAPM Part 806.3 OFOC SOP:

a. Contracting Officer Certification: I certify that the foregoing justification is accurate and complete to the best of my knowledge and belief.

PATRICE R. BOND

Contracting Officer NCO 12 – Medical Sharing Team Branch Chief

b. One Level Above the Contracting Officer & Division Manager: I certify the justification meets requirements for other than full and open competition.

Rich Hedman Division Chief, Construction/Specialized/Medical Sharing Teams

NCO 12

c. Director of Contracting: I certify the justification meets requirements for other than full and open competition.

Paul M. Lauro Director of Contracting

NCO 12

d. VHA RPO HCA Review and Approval: I have reviewed the foregoing justification and find it to be complete and accurate to the best of my knowledge and belief and approve for other than full and open competition.

Gerald F. Jacobs Acting Executive Director Regional Procurement Office-Central (VHA)

MANDI EVANSON Digitally signed by MANDI EVANSON Date: 2023.09.18 06:02:31 -05'00'

PATRICE BOND

Digitally signed by PATRICE

BOND

Date: 2023.09.18 07:21:05 -05'00'

RICH

HEDMAN

Digitally signed by

RICH HEDMAN

Date: 2023.09.18 07:46:32 -05'00'

21 Sep 2023 Paul M. Lauro 1463508

Digitally signed by Paul M. Lauro 1463508 Date: 2023.09.21 09:07:07 -05'00'

Attachment:

HCA Approval for Justification for Other than Full & Open Competition for the following Nursing Home Facilities:

VA STN Nursing Home Facility Acquisition Plan

Action ID Estimated Value Intent to Sole

Source No.

Intent to Sole Source Posting

Date 695 Luther Manor 36C252-23-AP-1621 $854,922.00 36C25223Q0347 2/2/2023 695 NSH Green Bay Health Services 36C252-23-AP-3534 $861,162.00 36C25223Q0712 8/15/2023 695 Southpointe Care and Rehab Center 36C252-23-AP-0536 $1,103,613.00 36C25223Q0164 3/17/2023 578 Peterson Park Healthcare 36C252-23-AP-3538 $1,268,980.09 36C25223Q0718 8/15/2023 695 Virginia Highlands Care and Rehab Center 36C252-23-AP-2843 $1,281,481.00 36C25223Q0564 4/26/2023 550 Mattoon Rehabilitation and Health Care 36C252-23-AP-3528 $1,314,241.00 36C25223Q0703 6/16/2023 607 NSH Lake Mills 36C252-23-AP-3535 $1,410,120.00 36C25223Q0714 8/15/2023 578 The Grove of Fox Valley 36C252-23-AP-0467 $1,724,564.00 36C25223Q0157 3/21/2023 578 Glenview Terrace Nursing Center 36C252-23-AP-3460 $1,882,842.69 36C25223Q0685 6/9/2023 578 Clark SNF 36C252-23-AP-2514 $2,411,150.00 36C25223Q0514 6/14/2023 537 Meadowbrook Bolingbrook Manor 36C252-23-AP-3475 $2,513,109.00 36C25223Q0688 6/12/2023 578 LaGrange SNF 36C252-23-AP-3516 $2,697,262.71 36C25223Q0701 6/14/2023 607 Evansville Manor Nursing and Rehab 36C252-23-AP-3585 $955,026.00 36C25223Q0732 6/23/2023 695 Waterfall Health of Brown Deer LLC 36C252-23-AP-4404 $907,482.04 36C25223Q0913 8/23/2023

Market Research Report for

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1. Objective: The objective is to conduct market research to determine if competition will be possible for placing veterans in nursing homes and to address the VA’s “Rule of Two”.

2. Background: VA’s Community Nursing Home (CNH) program has allowed the VA’s CNH program personnel, the veteran, and the veterans’ family to choose where a veteran is placed amongst the contracted VA nursing homes. For more than 35 years, the CNH Program has maintained two cornerstones: some level of patient choice in choosing a nursing home close to the veteran’s home and family; and unique approach to local oversight of CNHs.

3. Market Research Sources: CNH services are considered to be commercial services; therefore, market research for the solicitation is required and is a shared responsibility between the CNH program personnel (requestor) and the Contracting Officer (CO). This ensures maximum competition and that the requestor’s needs are met. Following are three (3) suggested market research sources that may be used for nursing home acquisitions. They are the VA websites for Veteran population data, Nursing Home Compare Website, and Contract Opportunities (see details below).

a. VA website for Veteran population data. This website can be utilized to determine the estimated number of Veterans (Veteran population) in any particular county of interest.

There are additional tables on this website that arrange information on the number of Veterans within particular age groups, by gender, ethnicity, etc. By using the data in examining the age of Veterans (among other factors), it is possible to estimate a reasonable number of Veterans that might require nursing home services. The data from this website also allows identification of possible areas that are currently under-served by VA nursing home contract facilities. If the Veteran population figures in a county are high and the number of nursing home contracted facilities is low, then the county is likely under-served. Under-served areas can be the subject of solicitation requirements.

b. Nursing Home Compare Website. The second resource recommended to conduct market research is the Centers for Medicare and Medicaid Services (CMS) which operates the Nursing Home Compare website. This website allows comparison of information on nursing homes. This tool essentially serves as a report card on nursing homes, as it contains quality of care information on every Medicare and Medicaid-certified nursing home across the country. CNH program personnel should be familiar with this website’s content and be able to assist the CO in navigating the website for market research purposes.

c. Intent to Sole Source. Before the solicitation is issued to the selected nursing home, an

Intent to Sole Source Notice will be posted to the SAM.gov | Contract Opportunities which is a suggested source for conducting market research.

4. Market Research Findings: The quality of care for the veteran will be accomplished through placement in a nursing home that is in close proximity to where the veteran and his family resides. Notably, in the VA’s community nursing home program, the veteran’s placement decision is made by VA, the veteran, and the veteran’s family. The placement decision will be based on established locale in the VA Indefinite Delivery / Indefinite Quantity (IDIQ) contract.

The geographic factor in these circumstances makes this requirement unique and, therefore, not subject to competition.

5. Customary Commercial Terms and Conditions: Customary commercial terms and conditions are outlined in the subject contract.

6. Market Price: Medicare rates are established by law and regulation. Differences in nursing home prices may be an add-on percentage to the Medicare rates or a discount percentage subtracted from the Medicare rates. These deductions and add-ons must be agreed to by the nursing home and VA.

7. Acquisition History: This procurement action is required to transition current Basic Ordering Agreements (BOAs) to IDIQ contracts. The anticipated effective date of the IDIQ is January 1, 2024. The current BOA VA251-15-G-0014 will expire on December 31, 2023. The BOA’s expiration date will be modified to align with the effective date of the IDIQ.

8. Other pertinent information: None.

9. Recommendations: According to 38 USC 8153, Sharing of Health Care Resources, the Rule of Two does not apply to sole source awards. However, the Contracting Officer shall consider the impact and determine the best method of successfully implementing the rule of two requirement according to the Veterans First Contracting Program. Although there are several factors that support the sole source decision, one critical factor in the initial placement effort combined with the medical need and availability of the nursing home facility, is the Veteran’s choice in a nursing home facility is based on proximity to family and home. Task orders or "consults" will not be competed under this contract because the unique requirement of location is present in placement of veterans under VA nursing home contracts and because the health of the veteran requires a sole source procurement.

Prepared by:

Name: Jackie S Voigt / September 6, 2023

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