36C25618Q0659-002.pdf

PAGE 1 OF 1. REQUISITION NO.

2. CONTRACT NO. 3. AWARD/EFFECTIVE DATE 4. ORDER NO. 5. SOLICITATION NUMBER

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 82

36C25618Q0659

6. SOLICITATION ISSUE DATE

6-08-2018

Christopher D. Vu 713.794.7727 12-31-2018

4:00PM

36C256

Department of Veterans Affairs

Network Contracting Office 16

Michael E. DeBakey VA Medical Center

2002 Holcombe Boulevard

Houston TX 77030 4298

X 0

623110

$27.5 Million

X

N/A

X

36C598

Department of Veterans Affairs

Central Arkansas Veterans HCS

2200 Fort Roots Drive, Building 41

Room 200 (90C/NLR)

North Little Rock AR 72114 1706

36C256

Department of Veterans Affairs

Network Contracting Office 16

Michael E. DeBakey VA Medical Center

2002 Holcombe Boulevard

Houston TX 77030 4298

Department of Veterans Affairs

Financial Service Center

PO Box 149971

Austin TX 78714-9971

1-877-353-9791 512-460-5429

Contractor to provide Community Nursing Home (CNH) Services to the Veterans of Central Arkansas Veterans Health Care

System in South Arkansas catchment area: Counties Grant, Polk, Prairie and Garland.

This is a multiple award solicitation in accordance with

Federal Acquisition Regulation (FAR) 12, FAR 13, FAR 13.5 and

FAR 16.504.

NTE

X

X one(1)

Christopher D. Vu

NCO1616L3-11004

36C25618Q0659

Table of Contents

SECTION A

A.1 SF 1449 SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL ITEMS

SECTION B - CONTINUATION OF SF 1449 BLOCKS

B.1 CONTRACT ADMINISTRATION DATA

B.2 SCHEDULE OF ITEMS (MEDICAID STATE OF ARKANSAS)/PRICE COST

SCHEDULE

B.3 PERFORMANCE WORK STATEMENT (PWS)

SECTION C - CONTRACT CLAUSES

C.1 52.212-4 CONTRACT TERMS AND CONDITIONS—COMMERCIAL ITEMS (JAN

2017)

C.2 52.252-2 CLAUSES INCORPORATED BY REFERENCE (FEB 1998)

C.3 52.204-21 BASIC SAFEGUARDING OF COVERED CONTRACTOR INFORMATION

SYSTEMS (JUN 2016)

C.4 52.216-18 ORDERING (OCT 1995)

C.5 52.216-19 ORDER LIMITATIONS (OCT 1995)

C.6 52.216-22 INDEFINITE QUANTITY (OCT 1995)

C.7 52.217-8 OPTION TO EXTEND SERVICES (NOV 1999)

C.8 VAAR 852.203-70 COMMERCIAL ADVERTISING (JAN 2008)

C.9 VAAR 852.203-71 DISPLAY OF DEPARTMENT OF VETERAN AFFAIRS HOTLINE

POSTER (DEC 1992)

C.10 VAAR 852.215-71 EVALUATION FACTOR COMMITMENTS (DEC 2009)

C.11 VAAR 852.216-73 ECONOMIC PRICE ADJUSTMENT—STATE NURSING HOME

CARE FOR VETERANS (MAR 2018)

C.12 852.216-74 ECONOMIC PRICE ADJUSTMENT—MEDICAID LABOR RATES (MAR

2018)

C.13 VAAR 852.232-72 ELECTRONIC SUBMISSION OF PAYMENT REQUESTS (NOV

2012)

C.14 VAAR 852.237-7 INDEMNIFICATION AND MEDICAL LIABILITY INSURANCE

(JAN 2008)

C.15 VAAR 852.237-70 CONTRACTOR RESPONSIBILITIES (APR 1984)

C.16 VAAR 852.270-1 REPRESENTATIVES OF CONTRACTING OFFICERS (JAN 2008) . 44

C.17 VAAR 852.271-70 NONDISCRIMINATION IN SERVICES PROVIDED TO

BENEFICIARIES (JAN 2008)

C.18 52.212-5 CONTRACT TERMS AND CONDITIONS REQUIRED TO IMPLEMENT

STATUTES OR EXECUTIVE ORDERS—COMMERCIAL ITEMS (JAN 2018)

SECTION D - CONTRACT DOCUMENTS, EXHIBITS, OR ATTACHMENTS

D.1 QUALITY ASSURANCE SURVEILLANCE PLAN (QASP)

D.2 SERVICE CONTRACT ACT WAGE DETERMINATION

D.3 (VA) COMMUNITY NURSING HOME PROGRAM LEVEL OF CARE – DESCRIPTION

- RUG IV

D.4 TECHNICAL CAPABILITY CHECKLIST (TECHNICAL QUOTE)

SECTION E - SOLICITATION PROVISIONS

E.1 52.212-1 INSTRUCTIONS TO OFFERORS—COMMERCIAL ITEMS (JAN 2017)

E.2 52.252-1 SOLICITATION PROVISIONS INCORPORATED BY REFERENCE (FEB

1998)

E.3 52.209-7 INFORMATION REGARDING RESPONSIBILITY MATTERS (JUL 2013)

E.4 52.216-1 TYPE OF CONTRACT (APR 1984)

E.5 52.216-27 SINGLE OR MULTIPLE AWARDS (OCT 1995)

E.6 52.233-2 SERVICE OF PROTEST (SEP 2006)

E.7 VAAR 852.209-70 ORGANIZATIONAL CONFLICTS OF INTEREST (JAN 2008)

E. 8 VAAR 852.215-70 SERVICE-DISABLED VETERAN-OWNED AND VETERAN-

OWNED SMALL BUSINESS EVALUATION FACTORS (JUL 2016)(DEVIATION)

E.9 VAAR 852.233-70 PROTEST CONTENT/ALTERNATIVE DISPUTE RESOLUTION

(JAN 2008)

E.10 VAAR 852.233-71 ALTERNATE PROTEST PROCEDURE (JAN 1998)

E.11 EVALUATION—COMMERCIAL ITEMS

E.12 52.212-3 OFFEROR REPRESENTATIONS AND CERTIFICATIONS—COMMERCIAL

ITEMS (JAN 2017)

SECTION B - CONTINUATION OF SF 1449 BLOCKS

B.1 CONTRACT ADMINISTRATION DATA

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

OFFEROR MUST COMPLETE AND RETURN ALL INFORMATION DESIGNATED IN

ADDENDUM to FAR 52.212-1 INSTRUCTIONS TO OFFERORS—COMMERCIAL ITEMS

(PAGE 57) PRIOR TO THE TIME SPECIFIED IN BLOCK 8 OF THE SF 1449 (PAGE 1) IN

ORDER TO BE CONSIDERED FOR AWARD. REQUIRED DOCUMENTS AND

INSTRUCTIONS FOR QUOTE SUBMISSION IS ON PAGE 57 – INSTRUCTIONS TO

OFFEROR FOR QUOTE SUBMISSION ADDENDUM TO FAR 52.212-1.

NOTIFICATION TO OFFEROR:

Federal Acquisition Regulations (FAR) require all contractors conducting business with the Government to be registered in the System Awards Management System (SAM) Government-wide online database for the provision of basic information relative to contract awards [refer to FAR Clause 52.212-4, para (t)].

You may accomplish registration online at the following web site:

SAM – http://www.sam.gov

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

a. CONTRACTOR:

DUNS Number: ___________________________________

TAX ID: _________________________________________

b. GOVERNMENT:

Christopher D. Vu, Contracting Officer

Department of Veterans Affairs

Network Contracting Office 16

2002 Holcombe Boulevard

Houston, TX 77030

Phone: 713-794-7727

Email: christopher.vu2@va.gov http://www.sam.gov/ mailto:christopher.vu2@va.gov

2. CONTRACTOR REMITTANCE ADDRESS: All payments by the Government to the contractor shall be electronically reimbursed:

[X} 52.232-33, Payment by Electronic Funds Transfer- System For Award

Management

[ ] 52.232-36, Payment by Third Party

3. INVOICES: Invoices shall be submitted in arrears:

a. Quarterly [ ]

b. Semi-Annually [ ]

c. Other [X] Monthly In Arrears

4. GOVERNMENT INVOICE ADDRESS: All Invoices from the contractor shall be submitted electronically in accordance with VAAR Clause 852.232-72 Electronic Submission of Payment Requests.

5. SECURE FAX: Please review VA Handbook 6500 that requires the following statement on all fax cover sheets be included: This fax is intended only for the use of the person or office to which it is addressed and may contain information that is privileged, confidential, or protected by law. All others are hereby notified that the receipt of this fax does not waive any applicable privilege or exemption for disclosure and that any dissemination, distribution, or copying of this communication is prohibited. If you have received this fax in error, please notify this office immediately at the telephone number listed above.

6. LIMITATIONS ON SUBCONTRACTING--MONITORING AND COMPLIANCE (JUNE 2011):

This solicitation includes FAR 52.219-4 Notice of Price Evaluation Preference for HubZone Small

Business Concerns. Accordingly, any contract resulting from this solicitation will include this clause. The contractor is advised in performing contract administration functions, the CO may use the services of a support contractor(s) retained by VA to assist in assessing the contractor's compliance with the limitations on subcontracting or percentage of work performance requirements specified in the clause. To that end, the support contractor(s) may require access to contractor's offices where the contractor's business records or other proprietary data are retained and 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's compliance with the limitations on subcontracting or percentage of work performance requirement.

7. SUBCONTRACTING COMMITMENTS--MONITORING AND COMPLIANCE (JUNE 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.

8. MADATORY WRITTEN DISCLOSURES (DEC 2008):

Mandatory written disclosures required by FAR clause 52.203-13 to the Department of Veterans Affairs, Office of Inspector General (OIG) must be made electronically through the VA OIG Hotline at https://www.va.gov/oig/hotline/ and clicking on "FAR clause 52.203-13 Reporting." If you experience difficulty accessing the website, call the Hotline at 1-800-488-8244 for further instructions.

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

AMENDMENT NO DATE

https://www.va.gov/oig/hotline/

B.2 SCHEDULE OF ITEMS (MEDICAID STATE OF ARKANSAS)/PRICE COST

SCHEDULE

1. Rate Determination: The VA is seeking preferred rates, based on patient care need. VA rates are an all-inclusive per diem rate. The per diem rate(s) will apply throughout the term of this IDIQ contract. While the VA uses State Medicaid rates as a reference, VA rates are independent of those payment systems and governed by the terms of this IDIQ contract. The per diem rate utilizes the

Medicaid Resident Assessment Instructions (RAI)/Minimum Data Set (MDS) assessment and RUGS score as the reference for rates. Assessment schedules identical to Medicaid will be used; in addition, the VA reserves the right to request a resident re-assessment at any time during the coverage period.

2. Rate Adjustments: Rate adjustments can be requested by either the VA or an authorized

Community Nursing Home (CNH) representative of the Contractor during the term of this IDIQ contract. Request for Rate adjustments must be accompanied by a justification for consideration by the Contracting Officer. If approved, the IDIQ contract must be modified and signed by both the

Contractor and the VA Contracting Officer. Rate adjustments are not effective until the IDIQ contract modification is signed by both the Contractor and the VA Contracting Officer. The effective date of the rate adjustment will be the actual “Effective Date” as indicated on the IDIQ contract or the modification.

3. 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.

4. Medications: All Medications administered to VA-contracted Veterans residing in a CNH will be charged at the Average Wholesale Price (AWP) or according to the pharmacy bill, whichever is less.

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 the 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. If for any reason the VA provides patient medications, the rate of reimbursement will be decreased by an agreed upon amount. 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.

5. Private Rooms: A private room rate for clinical concerns such as communicable diseases or infections (e.g., MRSA, 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.

6. Ventilator Care: Veterans requiring the use of a ventilator will only be placed in a CNH-trained and equipped for those types of specialty patients. The CNH must be inspected and approved by the

VA prior to any placements in the ventilator-designated room. Rates for ventilator care will be detailed in the pricing schedule and will be an all-inclusive per diem rate (including ventilator and supplies).

7. Specialized Prosthetics Equipment (e.g., special bed and/or bariatric equipment: Veterans may be eligible for specialized equipment when clinically indicated. Pre-approval required by VA.

PERIOD OF PERFORMANCE (Ordering Period): This is a multiple award IDIQ solicitation, based on the Government’s needs, more than one contractor may be awarded a IDIQ contract from this solicitation. Listed below are ordering periods that may be awarded to a contractor based on the

Government’s need. Depending on the Governments needs contractor may be awarded one of the five listed below ordering periods:

- One (1) year (12 months) ordering period from the date of award.

- Two (2) year (24 months) ordering period from the date of award.

- Three (3) year (36 months) ordering period from the date of award.

- Four (4) year (48 months) ordering period from the date of award.

- Five (5) year (60 months) ordering period from the date of award.

**Note** Task orders issued from the awarded IDIQ contract to provide CNH services will be only issued for a period of performance of one (1) year (12 months).

MEDICAID RATE+PERCENTAGE RATE = PER DIEM RATE (All-Inclusive Per Diem Rate)

DESCRIPTION OF CARE Medicaid Rate Plus

Percentage

All-Inclusive

Per Diem Rate

VA Behavior Symptoms & Cognitive

Performance

RUG IV: BB2, BB1, BA2, BA1

VA Reduced Physical Functioning

RUG IV: PE2, PE1, PD2, PD1, PC2, PC1,

PB2, PB1, PA2, PA1

VA Rehabilitation Therapy

RUG IV:

Ultra-high Rehabilitation – RUC, RUB, RUA

Very-high Rehabilitation – RVC, RVB, RVA

High Rehabilitation – RHC, RHB, RHA

Medium Rehabilitation – RMC, RHB, RHA

Low Rehabilitation – RLB, RLA

VA Rehabilitation + Extensive Services

RUG IV:

Ultra-high Rehabilitation + Ext Svs – RUX, RUL

Very-high Rehabilitation + Ext Svs – RVX, RVL

High Rehabilitation + Ext Svs – RHX, RHL

Medium Rehabilitation + Ext Svs – RMX, RML

Low Rehabilitation + Ext Svs – RLX

VA Extensive Services

RUG IV: SE3, SE2, SE1

VA Special Care High

RUG IV: HE2, HE1, HD2, HD1, HC2, HC1,

HB2, HB1

VA Special Care Low

RUG IV: LE2, LE1, LD2, LD1, LC2, LC1,

LB2, LB1

VA Clinically Complex

RUG IV: CE2, CE1, CD1, CC2, CC1, CB2,

CB1, CA2, CA1

VA Respite Care 0%

All Inclusive VA Per Diem Rates include the following: Drugs, Supplies, Oxygen, X-Ray, Laboratory, Physicians visits, Respiratory Therapies, and Rental Equipment.

Minimum Quantity (Minimum Guarantee): Cost of one (1) Veteran guarantee during the life of the IDIQ contract in the total amount of $1,000.00.

Maximum Quantity: Twenty (20) Veterans total at one time for the life of the IDIQ contract to be placed at the contractor’s facility for services (There will never be more than twenty (20) Veterans in a nursing home being provided services).

Six (6) Month Extension: As indicated in FAR 52.217-8 the Government will have the option provision to extend the performance of the contract up to an additional six (6) months when the contractor is provided written notice. Six (6) month extension will be based on Medicaid rates and the percentage from the final ordering period. Thus, providing separate pricing (percentage) for the optional six-month extension period is not required.

Prior to exercising the six (6) month extension, (1) the Contracting Officer will ensure that it is still in the Government’s best interest, with price and other factors considered, and (2) the options do not extend beyond the period of the Schedule contract.

Table A (All Inclusive VA PER DIEM)

SERVICE COVERED

BY PER-

DIEM

NOT

COVERED

BY PER

DIEM

NOTES

Room and Board X

Routine nursing care X

Physical Therapy X Pre-approval required (Paragraph 3) of this

Schedule of Items

Occupational Therapy X Pre-approval required(Paragraph 3) of this

Schedule of Items

Speech Therapy X Pre-approval required(Paragraph 3) of this

Schedule of Items

Respiratory Therapy X

Oxygen Therapy X

Provider visits (MD/NP) 1 per month Pre-approval required for additional visits

Routine Podiatry Care X

Nursing supplies X

Medications X Paragraph 4 of this Schedule of Items

Durable medical

Equipment

X Can be obtained through VA

Radiology Studies X

Lab Tests X

Specialized beds X Pre-approval and special authorization required of this Schedule of Items

Hospice Care X Veterans may be eligible for additional hospice program services, but must be separately authorized by VA.

Dialysis X Pre-approval and special authorization required of this Schedule of Items

Routine Transportation X

Specialized

Transportation

X Pre-approval and special authorization required of this Schedule of Items

UC/ER visits X Refer to Performance Work Statement

(PWS) section 2.1.6.

Hospitalizations X Refer to Performance Work Statement

(PWS) section 2.1.12

Psychology Services X Pre-approval and special authorization required of this Schedule of Items

Social Services X

Therapeutic

Recreational services

X

Pastoral Care X

Laundry/Linen service X

TPN/IV Therapy X Pre-approval and special authorization required of this Schedule of Items

Dental Care X Pre-approval and special authorization required of this Schedule of Items

Audiology Care X Pre-approval and special authorization required of this Schedule of Items

Eye Care X Pre-approval and special authorization required of this Schedule of Items

Custom Prosthetics X Pre-approval and special authorization required of this Schedule of Items

Specialized Wound

Care

X Pre-approval and special authorization required of this Schedule of Items

Private Room X See Paragraph 5 of this Schedule of Items

Ventilator Care X See Paragraph 6 of this Schedule of Items

**Note** Items not covered by per diem that require pre-approval and special authorization will be negotiated at the time of pre-approval and will be based on any applicable Medicaid rate.

B.3 PERFORMANCE WORK STATEMENT (PWS)

1. Overview

1.1. Federal Acquisition Regulation (FAR) – Indefinite Delivery Contract (IDC). In accordance with FAR 16.504, Indefinite-Quantity Contracts, this is an Indefinite Delivery, Indefinite Quantity (IDIQ) contract that will be solicited to multiple Contractors for award. There will be multiple ordering periods based on the needs of the Government. Reference page 8, section labeled “PERIOD OF

PERFORMANCE (Ordering Period)” for multiple ordering periods that may be awarded based from the date of award of the IDIQ contract (**Note** this section will be revised on the final contract document to reflect the actual ordering period of the awarded contract).

1.2. Services Rendered at Department of Veterans (VA) Per Diem Rates. Upon acceptance of a

VA patient by the Community Nursing Home (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.

The VA “Levels of Care” are defined in an attachment in Section D.3 of the solicitation and the IDIQ.

VA is obligated only to the extent authorized placement of patients is made in accordance with this IDIQ.

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

Ordering Officer Name: Veronica M. Pighee, LCSW

Address 2200 Fort Roots Drive, North Little Rock, AR 72114

Telephone number 501-251-3330

E-mail address veronica.pighee@va.gov

Facsimile number 501-257-3301

a. Ordering Officer/Contracting Officer Representative (COR) is required to provide a monthly expenditure report to the respective Contracting Officer/Contract Specialist and maintain an ordering officer order register/delivery log as required by VA PPM 2016-02.

b. Agency task and delivery order ombudsman (see 16.505(b)(8)) if multiple awards may be made.

1.3.1. Background/Introduction. The 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 Central Arkansas Veterans Healthcare System

(CAVHS) located at 2200 Fort Roots Drive, North Little Rock, AR 72114 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.

2. Requirements https://www.acquisition.gov/far/current/html/Subpart%2016_5.html#wp1095799 https://www.acquisition.gov/sites/default/files/current/far/html/Subpart%2016_5.html#wp1095799

2.1. 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 bed capacity to ensure their ability to take referrals when requested. The CNH also must be able to accept VA referrals in a timely fashion (ideally within 24 hours of request). Provider visits will be available at the rate of one (1) visit per month. Laboratory, x-ray, and other special services will be available to VA patients as needed. In addition, the care provided will include room, meals, nursing care, and other services or supplies commensurate with the VA-authorized level of care, without extra charge. 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 IDC will include the cost of primary medical care, one (1) provider visit per month and needed consultation, drugs and routine supplies, laboratory, x-ray, and other special services authorized by VA, unless otherwise specifically excepted (see Schedule of Items in this IDIQ for details regarding per diem rates and coverage). Full attention shall be given to motivating and educating patients to achieve and maintain independence in the activities of daily living. Every effort shall be made to keep patients ambulatory and to achieve an optimal level of self-care.

2.1.1. 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.

2.1.2. 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.

2.1.3. 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, routine medications, laboratory, x-ray, therapy (ies), and other special services authorized by VA, unless otherwise specifically exempted. VA will contract for appropriate Medicaid categories of care using

Resource Utilization Groups (RUG-IV) as a guide. As with Medicare, a description of the

RUG-IV systems can be found in 42 CFR Parts 409, et al.

2.1.4. 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).

http://www.va.gov/vhapublications/publications.cfm?pub=2

2.1.5. Rehabilitation Criteria. All therapy provided under this IDIQ contract 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.

2.1.5.1. 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.

2.1.5.2. 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.

2.1.6. 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 CAVHS 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.

2.1.7. 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.

2.1.8. State Licensure; Access to CNH Quality of Care Reports (QASP Indicator #1). The

CNH must maintain a current and unrestricted state license to operate as a skilled nursing facility. Changes in the status of the licensure will be immediately reported to the VA CNH

Coordinator (CAVHS) at 501-257-3330. VA will monitor the professional care and administrative management of services provided to VA beneficiaries under this IDIQ contract, 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 contract, 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.

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

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

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

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

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

e. Provide dates when corrective action will be completed.

2.1.10. Life Safety Code. The CNH’s building shall conform to the most recent standards of the Life

Safety Code (National Fire Protection Association Standard #101) in effect on the date of the

IDIQ contract 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

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

d. Major construction; additions; and renovations. Major construction including building additions or other renovations which may affect physical plant integrity; SHALL MEET latest

NFPA 101 Life/Safety Code requirements as well as any additional VA CNH construction standards in place at time of renovation or alteration.

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

2.1.12. Re-admission to the VA Hospital and Emergency Care; Notification of Death of

Veterans; CNH Responsibility to Veteran’s Belongings or Personal Effects (QASP

Indicator #3). VA beneficiaries who begin to require more than the level of care authorized by VA will be readmitted to an appropriate VA facility, as determined and authorized by VA.

a. When such an admission is not feasible because of the nature of the emergency, hospitalization in a non-Federal facility may be accomplished provided VA authorization is obtained. VA authorization must be obtained within 72-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 immediately of the death. In the event a death of a VA beneficiary while receiving nursing home care under this

IDC, the CNH will promptly notify the VA facility which authorized admission and immediately assemble, inventory, and safeguard the patient’s personal effects. The funds, deposits, and effects left by the VA patients upon the premises of the CNH shall be delivered by the CNH to the person(s) entitled thereto under the laws currently governing the CNH for making disposition of funds and effects left by patients, unless the beneficiary died without leaving a will, heirs or next of kin capable of inheriting.

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

2.1.13. Leave of Absence (LOA) – Bed-Hold Statement. For re-hospitalizations or therapeutic passes, CAVHS does not pay hold fees. Therapeutic passes will be authorized by the CNH staff based on individual patient needs, but are generally limited to six (6) days per calendar year and should be pre-approved. VA will cover therapeutic passes based on the therapeutic plan.

a. Absences of fifteen (15) consecutive calendar days or more, whether in a VA or in a non-Federal facility require a new authorization agreement. The nursing home is responsible to notify the family if a bed hold is required. The family would then make arrangements with the home to hold the bed.

2.1.14. Reportable Events (QASP Indicator #4). VA requires CNHs to report to the CNH

Coordinator at VA any of the following events within 24-hours or immediately the first business day after a weekend or holiday:

1. Sentinel events;

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

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

Service;

4. Substantiated allegations of mistreatment, neglect, abuse or misappropriation of CNH veterans or property;

5. Elopements of CNH veterans pursuant to state regulations;

6. Infectious outbreaks;

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

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

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

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

1. a fall resulting in death or injury;

2. elopement resulting in a missing patient;

3. patient abuse confirmed or under suspicion;

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

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

6. death related to an unconfirmed or suspicious cause.

When an adverse event occurs involving a CNH Veteran which is not determined to be a Sentinel Event but that the State requires that the occurrence be reported to the State), such event is also to be reported to

VA’s CNH program office. Some adverse events, such as minor medication errors without catastrophic outcomes, are managed by the CNH in the context of their quality improvement programs. It is not necessary for nursing homes to report such incidents to the CNH program office.

The Contractor shall report any violations i.e. Immediate Jeopardy; reflect CMS’ concern that crisis situations in which the health and safety of individuals (all residents/and Veterans beneficiary are accurately identified to the Government (VA Staff), by calling 501-257-3330, CNH Program Coordinator within twenty-four (24) hours.

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

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

b. Suspend placement of veterans in the CNH;

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

d. Not renew the IDIQ contract; and/or

e. Terminate the IDIQ contract.

2.1.16. VA Staff Access to CNH Records (QASP Indicator #5). All medical records concerning the veteran’s care in the CNH will be readily accessible to VA. Upon discharge or the death of a patient, medical records will be retained by the CNH for a period of at least five (5) years following termination of care. Patient records will be maintained in conformance with the

Privacy Act of 1974 (5 U.S.C. § 552a). A medical record shall be maintained for each patient, which includes at least the following:

a. VAHCS Referral Package to the CNH:

1. Copy of Physician Orders for Nursing Home Care; CPRS Notes; Discharge Summary including History & Physical information with Medication List; Rehabilitation

Progress Notes; and Veteran Demographic Record which includes next of kin information.

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

b. Nursing Home Clinical Record: The CNH must maintain clinical records on each veteran in accordance with accepted professional standards and practice. The clinical record must be: complete, accurately documented, readily accessible, systematically organized, and legible. Clinical records must contain at a minimum:

1. Sufficient information to identify the resident;

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

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

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

5. Medical practitioner orders which are signed and dated;

6. Allergies;

7. Person to contact in an emergency situation;

8. Name of attending medical practitioner; and

9. Advanced directives if available.

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

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

2.1.18. VA Health Care System Consultation/Resources.

2.1.18.1. After hours, weekends and holidays: For Urgent Referrals or consultations contact the

Admission Conference Call System number at 501-257-5714.

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

2.1.20. CNH Billing (QASP Indicator #6). Invoices for board, care and ancillary services shall be submitted promptly to the authorizing facility by the 15th calendar day following the end of the month in which services were rendered. The CNH will promptly notify the VA CNH

Coordinator regarding any change in Veteran status: discharge, transfer, against medical advice (AMA), hospitalization, death and/or any changes in payer source and any ability to complete timely billing. All invoices must include the full name and address of the CNH and shall reflect the patient’s name, social security number, number of days billed, RUG category

(ies), and agreed upon RUG rate (s). Failure to include this information may result in delayed payment. The current CNH Billing Cover Sheet can be obtained from the VA Care in the

Community (CITC) at 501-257-2484.

2.1.20.1. Pre-approves services billed by CMS procedures or CPT codes: All services which are pre-approved by VA as additional to the all-inclusive per diem rate must be billed according to CMS procedures or CPT codes. The CNH will be reimbursed based on local guidelines and VA pricing schedules.

2.1.20.2. High cost drugs: All requests for additional reimbursement for high cost drugs and corresponding billing are due as soon as possible, but no later than 90 calendar days after use of products.

2.1.20.3. Invoices: Corrected invoices must be submitted for additional payment of any ancillary costs or changes to the original billing. All corrected invoices must include all items that are affected by the change and should include the CNH corrected claim form from CITC at

501-257-2484.

2.1.20.4. Contractor will submit on a quarterly basis total amount invoiced and paid for current services that have been rendered to COR and Contracting Officer/Specialist. Submission schedule for total invoiced amount below for each quarter:

2.1.20.4.1. Quarter One (1) (October through December): No later than January 8 of each year.

2.1.20.4.2. Quarter Two (2) (January through March): No later than April 8 of each year.

2.1.20.4.3. Quarter Three (3) (April through June): No later than July 8 of each year.

2.1.20.4.4. Quarter Four (4) (July through September): No later than October 8 of each year.

2.1.21. Minimum Quantities; VA Payment. It is impossible to determine the exact or estimated amount, which will be expended under this IDIQ contract. No obligation will be incurred by

VA under this IDIQ contract, until authorizations are issued for nursing home care of specific beneficiaries. VA agrees to make payment on a timely basis for services rendered in accordance with such authorizations upon receipt of proper invoices submitted by the CNH as outlined in this IDIQ contract. VA will make payment for the day a recipient enters the CNH but not the day the recipient leaves a CNH unless entrance and departure are on the same day, then payment will be made for one (1) day.

2.1.22. VA Payments. Payments made by VA under any contract…