36C25520R0016-003.docx

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VISN-Wide Nursing Home Service Open-Continuous RFP - Multiple Requirements Combined Sources Sought and Request for Information
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36C25520R0016
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This document provides details regarding a solicitation for nursing home services across seven Veterans Health Administration networks. The solicitation seeks offers from nursing home facilities to provide care for veterans within specified counties in Illinois, Indiana, Kentucky, Missouri, Kansas, and Arkansas. Interested offerors are requested to provide information about their facilities including name, location, special capabilities, bed capacities, socioeconomic status, Medicaid reimbursement rates, private pay rates, staffing capabilities, and most recent CMS survey results by January 15, 2020. The anticipated award period is two years beginning on or around January 1, 2020. The Department of Veterans Affairs Veterans Health Administration Veterans Integrated Service Network 15 will issue this open and continuous solicitation and evaluate offers.

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36C25520R0016 Contract Deficiency Report.docx

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ATTACHMENT A: Contract Deficiency Report

CONTRACT DISCREPANCY REPORT

1. CONTRACT NUMBER

Report Number:
Date:

2. TO: (Contractor and Manager Name)

3. FROM: (Contracting Officer’s Representative Name)

DATES

CONTRACTOR NOTIFICATION:

CONTRACTOR RESPONSE DUE BY:
RETURNED BY CONTRACTOR:
ACTION COMPLETE:

4. DISCREPANCY OR PROBLEM (Describe in detail; Include reference in PWS / Directive. Attach continuation sheet if necessary.)

5. SIGNATURE OF CONTRACTING OFFICER’S REPRESENTATIVE (COR)

6. TO: (COR)

7. FROM: (Contractor)

8. CONTRACTOR RESPONSE AS TO CAUSE, CORRECTIVE ACTION, AND ACTIONS TO PREVENT RECURRENCE (Attach continuation sheet if necessary.)

9. SIGNATURE OF CONTRACTOR REPRESENTATIVE

10. DATE

11. GOVERNMENT EVALUATION OF CONTRACTOR RESPONSE/RESOLUTION PLAN (Acceptable response/plan, partial acceptance of response/plan, rejection. Attach continuation sheet if necessary)

12. GOVERNMENT ACTIONS (Payment withholding, cure notice, show cause, other.)

CLOSE OUT

NAME AND TITLE
SIGNATURE
DATE

CONTRACTOR

NOTIFIED

COR

CONTRACTING

OFFICER

VHAPM Part801.603-70 COR SOP Revision 06 Page 1 of 1 Original Date: 05/20/2011 Revision 05 Date: 03/11/2019

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