36C25718Q9554-002.docx

B.2 PERFORMANCE WORK STATEMENT

Performance Work Statement Under the authority of Public Law 104-262 and 38 USC 1720, the contractor agrees to provide Health Care Resources in accordance with the terms and conditions stated herein, to furnish to and for the Department of Veterans Affairs Medical Center, the services and prices specified in the Section entitled Schedule of Supplies/Services of this contract.

SERVICES:

This is an Indefinite-quantity contract (IDC) for the period from XXXXXX to XXXXXX . A contract is formed, in accordance with the terms and conditions of this contract, when the Department of Veterans Affairs (VA) agrees to place a patient in the Contract Adult Day Health Care (CADHC) and the CADHC agrees to accept the patient. Upon acceptance by the contractor of beneficiaries of the VA, all terms and conditions of this contract shall apply during such time as the VA patient remains in that CADHC at the expense of the VA.

The Contractor shall provide all necessary personnel, equipment, and supplies associated with the full range of CADHC services in performing the requirements of this contract within the terms, conditions, and provisions of this contract.

The following geographic areas will be targeted:

Tarrant County Dallas County Choctaw County Bryan County Sherman County Palo Pinto County Navarro County Camp County Van Zandt County Cooke County Hood County Delta County Wood County Red River County Henderson County Hopkins County Titus County Lamar County Franklin County Fannin County Hunt County Montague County Clay County Smith County Kaufman County Stephens County Grayson County Rains County Johnson County Parker County Somervell County Wise County Callahan County Eastland County Throckmorton County Baylor County Jack County Archer County Young County Ellis County Denton County Rockwall County Midland County Durant County

This IDC is entered into under the authority in 38 CFR 1720.

Either party may discontinue the IDC upon 30 days’ written notice. This contract termination shall be effective on the 31st day following that notification.

The Contracting Officer shall review the IDC annually before the anniversary of its effective date and if necessary issue a modification to incorporate any statutory requirements.

The services specified in the Sections 3.2 through 3.12 may only be changed by written modification to this IDC.

Upon acceptance of a VA patient by the CADHC, if and when requested by the Contracting Officer or authorized representative, the contractor shall furnish all supplies and services herein described, at the rates specified below. VA is obligated only to the extent authorized placements of patients are made under this contract.

Contractors must have and maintain, for the life of the contract, current State Licensure to meet the requirements of this contract.

REQUIREMENTS

The purpose of providing CADHC is:

to enable functionally impaired individuals to reside in supportive home environments rather than in nursing home care facilities;

to facilitate the return of older veterans to their home and coordinate long term care there by reducing readmissions to hospitals and nursing homes;

to maintain the elder veteran at the highest level of functioning possible;

to improve the quality of life for the participants; and to provide support for the family and other caregivers of elder veterans.

The Contractor shall provide medical services, nursing, social work services, assistance with activities of daily living, activity therapy, case management, nutrition service including meals and snacks, restorative care, and transportation.

Full attention shall be given to motivating and educating patients to achieve and maintain independence in activities of daily living to the maximum extent possible. Every effort shall be made to keep patients ambulatory and to achieve an optimal level of self-care.

The Contractor shall not maintain nor provide dual or segregated patient facilities which are segregated on the basis of race, creed, color or national origin. The Contractor shall neither require such segregated use by written or oral policies nor tolerate such use by local custom. The term "facilities" shall include but not be limited to rooms, wards, sections, eating areas, drinking fountains, and entrances, and other like areas.

The CADHC shall accept referral of and shall provide all services specified in this contract for any person determined eligible by the VA Chief Medical Director or his/her designee, regardless of the race, color, religion, sex or national origin of the person for whom such services are ordered. In addition, the CADHC Program warrants that subcontracting will not be resorted to as a means of circumventing this provision.

All medical records concerning the veteran's care in the CADHC will be readily accessible to the VA. Upon discharge or death of the patient, medical records will be retained by the CADHC contractor for a period of at least three 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 that includes at a minimum the following:

Admission record, including assessment and diagnosis Physician orders Treatment plan Progress notes Periodic evaluations Discharge Summaries Other usual and customary information pertinent to patient care

The beneficiary will be provided CADHC at the expense of VA for a period not in excess of that stated in the referral/Authorization form, unless an extension of the authorization is provided in writing by the placing VA facility.

If the VA Medical Center and the CADHC Provider agree that the VA shall provide services under 38 CFR 17.51(f), the contract will be incorporated into the contract and either the per diem rate will be re-established, or direct payment made to the United States to reflect the cost of VA's contribution.

The Contractor shall submit a properly executed invoice form monthly for each VA funded participant to VA Fee Services for the purpose of claims processing.

Absences of the patient from the CADHC Program will not be reimbursable.

Payment made by the Department of Veterans Affairs under this contract will constitute the total cost of CADHC. The Contractor shall not apply additional charges to be billed to the beneficiary or his/her family, whether by the contractor or any third party furnishing services or supplies required for such care, unless and until specific prior authorization in writing is obtained by the Department of Veterans Affairs facility that authorized payment.

ADULT DAY HEALTH CARE (ADHC) SERVICES

Activities: Therapeutic programming includes recreational services and leisure activities to meet the physical and social needs of the participants and is an integral part of each client’s treatment program. The intent of these services is to provide a method for participants to use their time meaningfully during each session. These services and activities may include, but are not limited to, arts and crafts, music, TV and radio stimulation, physical exercise, books and magazines, games, field trips, and other appropriate activities.

Nutrition: The Contractor shall provide two (2) snacks, one (1) in the morning and one (1) in the afternoon, and one (1) hot lunch daily between 11:00am and 1:00pm. The Contractor shall receive appropriate dietician consultation in accordance with state guidelines.

Special Diets/Feeding Needs: The Contractor shall provide special diets, enteral feeding, and cutting of food and/or hand feeding when required under the supervision of a registered dietitian.

Personal Care Assistance: The Contractor shall provide reminders and/or directions for continence care and stand-by assistance/supervision with personal care such as toileting, dressing, and bathing when needed.

Incontinence Care: The Contractor shall provide full assistance in toileting, catheter care, disposable undergarments, and changing/laundering of soiled clothing, as required.

Supervision: The Contractor shall provide a high degree of safety supervision for wandering/ambulating, and/or behavioral supervision for combativeness, agitation, aggression, withdrawal, etc.

Physical Transferring: The Contractor shall provide physical assistance/ human help or lifting for transferring in order to accomplish personal care, transportation, safety, incontinence care, etc.

CLINICAL SERVICES

Nursing Services: The Contractor shall provide skilled nursing services to include medication administration (oral and injectable), necessary nursing treatments, and supervision of prescribed therapies (Oxygen, range of motion, etc.) In addition, the CADHC program will manage the patient plan of care while providing the patient’s social and health needs. The CADHC must meet State Requirements for nursing services. There shall be at least one licensed registered nurse or licensed vocational nurse on duty during the main hours of operation to provide ongoing nursing assessments and skilled nursing care, as needed. There shall be sufficient nurses and/or Nursing Assistants (NA) to provide supportive nursing care and assistance in daily program activities. At a minimum, the facility must employ a full time licensed vocational nurse under the supervision of a registered nurse consultant. The registered nurse consultant must provide on-site consultation four hours per week. The ratio of direct service staff to clients shall be at least one staff person for every eight patients during provision of all covered services except during facility provided transportation. Staff counted in the veteran to staff ratio are only those who spend at least 70% of their time in direct care services.

Medical Services: A VA physician shall provide primary medical services. There shall be a Physician Medical Director to review the CADHC facility’s clinical policies and procedures annually.

Social Services: Each Veteran referred for contracted services will have a VA Social Worker assigned for oversight requirements. General social services should be available as an integral part of the program to provide social assessments and appropriate counseling/referrals to participants and their caregivers.

Rehabilitation Services: Maintenance therapies shall be provided as part of the ongoing therapeutic program. All restorative therapies must be provided under the supervision of a qualified physical and/or occupational therapist on a consultative basis when indicated and or requested by the VA.

Nutrition Services: Nutrition services shall be provided, with the consultation of a Registered Dietician as necessary, to include counseling, regular meals, and special diets.

Recreation Services: As an integral part of the individual treatment program, recreational services shall be provided to meet the physical and social needs of the participants.

TRANSPORTATION

ADHC's primary role is in facilitating Veterans’ maximum use of community transportation systems, identifying systems, aiding in the application process, etc. Such systems may include:

Area "Agency on Aging" supported transportation;

Caregivers;

Regional transit;

Local handicapped transportation resources;

Veteran Service Organization vehicles; and Volunteer transportation systems, etc.

When there is a lack of adequate community transportation systems, coordination of local Disabled American Veteran (DAV) transportation services may be sought.

If authorized by the VA, and at the option of the beneficiary, the Contractor may directly provide transportation (in properly equipped, maintained, licensed and insured vehicle and operated by a licensed driver) or utilize appropriate public transportation. Services provided will be paid by the Contractor and will be invoiced to the VA not to exceed the VA Approved Rate for Transportation as specified in the Price Schedule, if applicable.

If the contractor only provides transportation to or from a location described above, the amount due for the applicable service above will be one half of the round-trip rate.

At the option of the beneficiary, and at no additional cost, the Contractor is responsible for assisting the beneficiary in arranging transportation from and return to the beneficiary’s place of residence. Transportation may be provided via privately operated vehicle (POV) by a friend or relative of the beneficiary, or by an activity providing veteran transportation as a public service. If any of these forms of transportation are provided the Contractor will not be responsible or liable for the transportation and will not be compensated for the services provided.

The Contractor will not bill the beneficiary, his/her family, or any third party, for any transportation provided under this contract.

AUTHORIZATIONS

This Indefinite Deliver Contract (IDC) is established for providing VA beneficiaries community ADHC services in a Contractor furnished facility. The primary user of this contract will be the North Texas VA Healthcare System. Other VHA activities may utilize this contract and are authorized to place eligible beneficiaries. It is the Contractor’s responsibility to verify the authority of any individual attempting to make a placement and to promptly notify the VA facility’s Contracting Officer’s Representative (COR) of any placement made by a different VHA activity.

VA FORM 10-1349. Authorizations for ADHC services will be accomplished on a VA Form 10-1349, Social Work Service – Reports and Summaries CADHC Placement Assessment and Plan. Each authorization validity period will be from the initial effective date to disposition. Any extension to the original authorization validity period, regardless of the number of days, requires approval of CADHC Program Coordinator or his/her designee.

VA INDIVIDUALS AUTHORIZED TO PLACE BENEFICIARIES. All authorizations must be initiated by and confirmed by the authorized Contracting Officer’s Representative (COR) of which a copy of the authorization will be provided to the Contractor.

Placements will be made in contract facilities based on availability of facilities and the desires of the veterans and their respective families. It is impossible to determine actual usage of any particular contract facility.

CHANGE TO THE IDC. No individual or activity has authority to ADD, DELETE, CHANGE, MODIFY or TERMINATE this contract other than the warranted Contracting Officer.

SPECIAL TERMS AND CONDITIONS

Referral and Acceptance of Clients: It is understood that veterans to be cared for under this contract, as referred by the Associate Chief of Staff, Geriatrics and Extended Care Product Line, or his/her designee, shall receive the CADHC services as a substitute for nursing home care. The purpose of providing CADHC services is to:

Facilitate the ability of impaired veterans to remain in their home and coordinate long-term care, thereby reducing readmission to hospitals and nursing homes.

Maintain the impaired veteran at the highest level of functioning.

Improve the quality of life for the participants among their peers.

Provide support for the family and other caregivers of older veterans.

Authorization For Extension of Services: A VA beneficiary may not be provided CADHC services at the expense of the VA for a period in excess of that stated in the treatment plan received from the VA, unless an extension of the authorization is provided, in writing, by the Community Adult Day Health Care Program Coordinator, or his/her designee.

Changes: Changes to this contract may be made only by written modification to this contract. The modification shall be prepared by the VA Contracting Officer and, prior to becoming effective, approved and signed by the Contractor.

CONTRACTOR REQUIREMENTS

The Contractor shall appoint a Program Manager at each Community Adult Day Health Care center covered by this contract) who shall be the Contractor’s authorized representative for technical and administrative performance of all services required at that CADHC. Contractors are expected to accept or reject veterans within 24-hour of referral. Once the patient is accepted for placement, the patient will be admitted to the adult day care on the next business day or at the patient’s convenience not to exceed three weeks from referral. If this time frame is exceeded the CADHC will notify the Program Coordinator.

All clinical concerns regarding this contract will be forwarded to the CADHC Program Coordinator.

Full attention shall be given to motivating and educating patients to achieve and maintain independence in activities of daily living. Every effort shall be made to keep patients ambulatory and to achieve an optimal level of self-care.

Patients who require more than the level of care safe for CADHC will not be admitted or retained. The CADHC staff will notify the VA for direction.

The Veteran will be discharged when the Veteran is no longer able to participate and/or benefit from CADHC services, has achieved the expected outcomes or treatment goals, develops needs beyond the capability of the program or demonstrates chronic non-adherence that results in serous health or safety concerns or is otherwise unable to tolerate or be managed in a group setting.

The CADHC shall not maintain nor provide dual or segregated patient facilities that are segregated on the basis of race, creed, color, national origin or medical condition (except as dictated by standard infection control procedures). The CADHC shall neither require such segregated use by written or oral policies, nor tolerate such use by local custom.

The CADHC shall provide all services specified herein for any VA patient, regardless of the race, color, religion, sex, national origin or medical condition of the person for whom such services are ordered. In addition, the CADHC warrants that subcontracting will not be resorted to as a means of circumventing this provision.

The CADHC shall allow reasonable visitation rights to family and to other persons who have a care-giving or significant relationship to the patient while the patient is attending CADHC.

It is agreed that duly authorized representatives of VA will provide follow-up visits to veterans placed on contract to ascertain continuity of care and to assist in the veteran’s transition back to the community. It is understood that these visits do not substitute for, nor relieve the adult day care in any way of the responsibility for the daily care and medical treatment of the veteran.

The beneficiary will be provided adult day care at the VA’s expense for a period not to exceed that stated in the treatment plan received from VA on admission.

Contractors providing care will:

Admit patients to CADHC processing all required paperwork.

Utilize the nursing process in assessing, planning and implementing and evaluating patient care.

Manage the adult day healthcare plan for the veteran assuring that such care meets or exceeds State Licensing requirements.

The Contractor will coordinate the adult day health care, supervise its own staff and evaluate the care and services provided to each veteran on contract.

The Contractor will assure that adequate staffing is available for the provision of care to meet the needs of the veterans.

The Contractor assures that the discharge plan is developed using appropriate resources to meet the veterans’ needs.

Required documentation. The following reports are required for the duration of the contract.

Telephone contact, with written notification to follow, will be made regarding any veteran on contract who experiences a sentinel event, death, major change in condition or reports abuse. Telephone contact will be made to the Program Coordinator for Community Adult Day Health Care or the Administrative Officer of the Day during non-business hours.

QUALIFICATIONS:

Accreditation: The Contractor shall be licensed as an Adult Day Health Care facility by the state of Texas or (Oklahoma for Choctaw and Durant counties only).

Compliance: The Contractor’s CADHC facility shall meet all Federal, State, and local laws, regulations, and codes pertaining to health and safety such as those regulating:

Construction, maintenance, and equipment.

Sanitation and waste management.

Buying, dispensing, safeguarding, administering, and disposing of medications and controlled substances.

Also, it is understood that the facility shall meet the requirements of Public Law 100-336, 42 USC 12101-12213, Americans with Disabilities Act pertaining to handicapped accessibility.

VA Standards: The Contractor’s CADHC facility shall meet the VA standards for Adult Day Health Care (CADHC) Services as promulgated in 38 CFR Part 17.51c through 17.51e.

License: The Contractor’s CADHC facility shall be licensed to operate as such in compliance with the State of Texas requirements; (or the State of Oklahoma for Choctaw and Durant counties only).

Liability: See VAAR Clause 852.237-7, Indemnification and Medical Liability Insurance.

Personnel: Personnel employed by the Contractor to perform the CADHC services covered by this contract shall be licensed and/or certified in a State, Territory, or Commonwealth of the United States or the District of Columbia in accordance with the State of Washington and all applicable Federal laws and regulations. Personnel must meet the minimum training and experience qualifications for position employed in according to Washington State rules.

Fire Laws: The Contractor’s facility shall conform to the standards of the current National Fire Protection Association (NFPA) Life Safety Code #101 and shall provide sufficient staff to assist patients in the event of fire or other emergency. The Contractor shall certify that their CADHC facility is in compliance with all applicable fire laws and that there are no recommendations of fire officials that have not been resolved.

PERSONNEL POLICY:

Responsibility: The Contractor shall be responsible for protecting the personnel furnishing CADHC services under this contract and, thus, shall provide the following to carry out this responsibility:

Worker’s Compensation Professional Liability Insurance Health Examinations Withholding Income Tax Social Security Payments

Non-VA Employees: The parties agree that such personnel shall not be considered VA employees for any purpose and shall be considered employees of the Contractor.

Staffing Requirements: The facility must observe the following staffing requirements:

One licensed registered nurse or licensed vocational nurse must be working on site during the main hours of operation to provide ongoing nursing assessments and skilled nursing care as needed. At a minimum, the facility must employ a full time licensed vocational nurse under the supervision of a registered nurse consultant. The registered nurse consultant must provide on-site consultation four hours per week.

There shall be sufficient nurses and/or nursing assistants to provide supportive nursing care and assistance in daily program activities. The ratio of direct service staff to clients shall be at least one staff person for every eight patients during provision of all covered services except during facility provided transportation.

The facility must employ a Director who works full time, a minimum of 32 hour per week with emergency availability, performing duties related to the provision of adult day care service.

The facility must employ an Activities Director full time, a minimum of 32 hours per week, responsible for planning and directing the daily program activities including physical fitness exercises and other recreational activities.

The contracting nutrition provider must receive consultation from a dietician. The dietitian consultant plans and/or reviews menus and approves snack and luncheon menus.

Points of Contact (POC): The CADHC agency shall provide a Point of Contact (POC) who shall be responsible for the performance of the work under this contract. The POC shall have full authority to act for the CADHC agency on all matters relating to the daily operation of this contract. The POC must be a health care provider performing in accordance with the terms and conditions of this contract. An alternate may be designated, but the CADHC agency shall identify, in writing, those times when the alternate shall act as the POC. The CADHC agency shall identify the POC and alternate in writing to the VA COR at the time submission of offer, and confirmed upon award of contract and upon the extension of each option period. The CADHC agency shall give written notification to the COR of those times when the alternate will act as the POC. In case of EMERGENCY, the POC must be available by telephone at all times (24 hours/7 days a week), Sunday through Saturday, including Federal holidays.

PATIENT RECORDS/RECORD KEEPING SYSTEM:

Compliance: The Contractor shall maintain a record on each client to include a treatment plan, initial and periodic reevaluations, progress notes, and other usual/customary information included in client records according to state standards.

Access to Medical Records: All medical and administrative records concerning the patient’s care in the CADHC program will be readily accessible to the Department of Veterans Affairs. Upon discharge or death of the patient, the CADHC program shall retain medical and administrative records on all VA beneficiaries for a period of at least three (3) years following termination of care. Patient records will be maintained in conformance with the latest Privacy Act, and HIPPA regulations. A medical record shall be maintained for each patient and at a minimum will include:

Admission identification record Nursing assessment and treatment plan Physician orders as required by state licensing requirements Progress notes from nursing, dietary, and activity disciplines of patient response to ADHC services Documentation whether or not individual patient has executed an advance directive.

Reports: The CADHC program shall submit a monthly report on the attendance, medical, functional, and psychosocial status of the beneficiaries receiving care under this contract. The report shall be sent to the Program Coordinator.

CONTRACTING WITH PARTIES LISTED ON THE OIG LIST OF EXCLUDED INDIVIDUALS/ENTITIES:

In accordance with The Health Insurance Portability and Accountability Act (HIPAA) and the Balanced Budget Act (BBA) of 1977, the Office of Inspector General has established a list of parties and entities excluded from Federal health care programs. Specifically, the listed parties and entities may not receive Federal Health Care program payments due to fraud and/or abuse of the Medicare and Medicaid programs.

Therefore, all offerors shall review the OIG List of Excluded Individuals/Entities on the OIG web site at www.hhs.gov/oig to ensure that the proposed candidate(s) and/or firm(s) are not listed. Offerors should note that any excluded individual or entity that submits a claim for reimbursement to a Federal health care program, or causes such a claim to be submitted, may be subject to a Civil Monetary Penalty (CMP) of $10,000 for each item or service furnished during a period that the person or entity was excluded and may also be subject to treble damages for the amount claimed for each item or service. CMPs may also be imposed against health care providers and entities that employ or enter into contracts with excluded individuals or entities to provide items or services to Federal program beneficiaries.

By signing the offer/bid, the Contractor certifies that he/she has reviewed the OIG List of Excluded Individuals/Entities and that the proposed candidate(s) and/or firm are not listed as of the date the offer/bid was signed.

ADMINISTRATIVE REQUIREMENTS AND PROCEDURES

Payment Terms And Conditions: As it is impossible to determine the exact or estimated amount which will be expended under this contract, it is understood that no obligation will be incurred by the Department of Veterans Affairs, under this contract until authorizations are issued for CADHC services for specific beneficiaries. The VA agrees to make payment on a timely basis for CADHC services rendered in accordance with such authorizations upon receipt of billings submitted by the Contractor’s CADHC facility at the completion of each month’s CADHC services.

Invoices: The Contractor shall submit monthly, by the fifth (5th) calendar day of each month, an invoice for services performed under the contract during the previous month. One (1) payment shall be made per month. All invoices shall include the following information:

Name, address, telephone number, and tax identification number of Contractor.

Invoice date.

Contract number or other authorizations for payment.

Number/dates of days billed; a daily attendance roster for each client must be submitted with billing.

Name and social security number of VA beneficiaries to who services were provided.

*Unit rate, Total number of units attended, and total dollar amount.

Invoices shall be submitted in arrears on a monthly basis.

*Unit Cost is the method of payment. A unit of authorized service is defined as half a day, if applicable. One unit of service constitutes four hours of covered services provided by the CADHC facility, if applicable. Five hours or more of service constitutes two units of service, if applicable. Time spent in approved transportation provided by the CADHC facility shall be counted in the unit of service.

Billings in Full: Invoices submitted by the Contractor to the Department of Veterans Affairs for CADHC services furnished to a VA beneficiary under the terms of this contract shall be billings in full. The Contractor shall neither bill the beneficiary, his/her insurer, nor any other third party.

DEPARTMENT OF VETERANS AFFAIRS RESPONSIBILITIES

Inspections:

Inspection Team: The Department of Veterans Affairs shall have the right to inspect the Contractor’s CADHC facility/program by an authorized representative(s) designated by the Department of Veterans Affairs to determine whether acceptable standards are maintained and that adequate care is being rendered. Prior to award and during the term of this contract, all inspections will be carried out by an interdisciplinary team consisting of a Social Worker, Registered Nurse, Dietitian, and Fire Safety Specialist.

Deficiencies: If deficiencies are noted during any inspection, the Contractor will be advised of the inspection team’s findings and given a reasonable time to take corrective action. Any deficiencies shall be documented and MUST be corrected within the timeframe specified by the inspection team. The Contractor will notify the Program Coordinator when correction(s) have been made. However, if inspection deficiencies are found prior to award of the contract, the contract shall not be awarded until noted deficiencies have been eliminated/resolved.

Follow-Up Supervision Visits: Duly authorized representatives of the Department of Veterans Affairs shall provide follow-up supervision visits to veterans placed in the Contractor’s CADHC facility to assure the continuity of care and to assist in the patient’s transition back into the community. It is understood that these visits do not substitute nor relieve the CADHC program in any way of the responsibility for the daily care and medical treatment of the veteran.

Evaluation: The Department of Veterans Affairs may evaluate the quality of professional and administrative services provided, but retains no control over the medical/professional aspects of services rendered (e.g., professional judgments, diagnosis for specific medical treatment) in accordance with FAR 37.401(b).

Payment: Payments made by the VA under this IDC constitute the total cost of CADHC services. No additional charges shall be billed to the beneficiary or his/her family. The Contractor shall not solicit contributions, donations, or gifts from patients or family members. The VA agrees to make payment on a timely basis for services rendered in accordance with the Payment provision and upon receipt of properly submitted invoices.

Termination of Services: The VA reserves the right to remove any or all VA patients from the ADHC program at any time, when it is determined to be in the best interest of the VA or the patient.