36C25718Q9554-003.doc

B.2 PERFORMANCE WORK STATEMENT

DESCRIPTION/SPECIFICATIONS

Contractor is to provide adult day care to eligible veterans enrolled in the Department of Veterans Affairs, South Texas Veterans Health Care System (STVHCS) with all terms, conditions, and provisions of this contract. All contractors must have current State Licensure to meet the requirements of this contract.

PERFORMANCE WORK STATEMENT

The Contractor shall provide the following Adult Day Health Care (ADHC) Services to all eligible veterans upon referral by the Associate Chief of Staff, Geriatrics and Extended Care Product Line, or his/her designee, of the South Texas Veterans Health Care System (STVHCS), San Antonio, Texas. The Contractor shall provide all necessary personnel, equipment, and supplies associated with the full range of ADHC services in performing the requirements of this contract. Contractor's facility shall be geographically located within the STHVCS region in order to service veterans residing in those areas.

The following services shall normally be provided to all patients by the Contractor at no additional charge:

I. ADULT DAY HEALTH CARE (ADHC) SERVICES

A. 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.

B. 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.

C. 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.

D. 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.

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

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

G. 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.

II.

CLINICAL SERVICES

A. Nursing Services: The Contractor shall provide skilled nursing services to include medication administration (oral and injectables), necessary nursing treatments, and supervision of prescribed therapies (Oxygen, range of motion, etc.) In addition, the ADHC program will manage the patient plan of care while providing the patient’s social and health needs. The ADHC 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.

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

C. 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 to participants and their caregivers.

D. 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.

E. Nutrition Services: Nutrition services consisting of 4 hours a month shall be provided, with the consultation of a Dietitian to include counseling, regular meals, and special diets. A license is not required to use the title Dietitian. A person licensed by the Texas State Board of Examiners of Dietitians or a person with a Baccalaureate Degree with major studies in food and nutrition, dietetics, or food service management can serve as a dietitian consultant.

F. 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.

III.

TRANSPORTATION

Contractor shall provide handicapped accessible transportation to/from client or caretaker’s home or assist the veteran in securing community resources. If the facility employs a driver, the driver shall operate the facility’s vehicle in a safe manner; maintain adult cardiopulmonary resuscitation (CPR) certification; and be capable of assisting individuals to board/exit the vehicle.

IV.

SPECIAL TERMS AND CONDITIONS

A. 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 ADHC services as a substitute for nursing home care. The purpose of providing ADHC services is to:

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

2. Maintain the impaired veteran at the highest level of functioning.

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

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

B. Authorization For Extension Of Services: A VA beneficiary may not be provided ADHC services at the expense of the STVHCS for a period in excess of that stated in the treatment plan received from the STVHCS, San Antonio, Texas, unless an extension of the authorization is provided, in writing, by the Associate Chief of Staff, Geriatrics and Extended Care, or his/her designee.

C. 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.

D. Term of Contract: This contract is effective for one year from date of award and is subject to the availability of VA funds.

V.

CONTRACTOR REQUIREMENTS

A. Qualifications:

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

a. Construction, maintenance, and equipment.

b. Sanitation and waste management.

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

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

3. License: The Contractor’s ADHC facility shall be licensed to operate as such in compliance with the State of Texas requirements Title XIX; 1915c (Medicaid Waiver Program)

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

5. Personnel: Personnel employed by the Contractor to perform the ADHC 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 Texas and all applicable Federal laws and regulations. Personnel must meet the minimum training and experience qualifications for position employed in according to Texas State rules.

6. 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 ADHC facility is in compliance with all applicable fire laws and that there are no recommendations of fire officials that have not been resolved.

B. Personnel Policy:

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

a. Professional Liability Insurance

b. Withholding Income Tax

c. Social Security Payments

2. 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.

3.

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

a. 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.

b. 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.

c. The facility must employ a Director who works a minimum of 40 hours per week performing duties related to the provision of adult day care service.

d. The facility must employ an Activities Director at 40 hours a week responsible for planning and directing the daily program activities including physical fitness exercises and other recreational activities.

e. The facility must receive on site consultation at least four hours each month from a dietician. The dietitian consultant plans and/or reviews menus and must approve each snack and luncheon menu.

C. Patient Records/Record Keeping System:

1. 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.

2. Access to Medical Records: All medical and administrative records concerning the patient’s care in the ADHC program will be readily accessible to the STVHCS. Upon discharge or death of the patient, the ADHC 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:

1. Admission identification record

2. Nursing assessment and treatment plan

3. Physician orders as required by state licensing requirements

4. Progress notes from nursing, dietary, and activity disciplines of patient response to ADHC services

5. Documentation whether or not individual patient has executed an advance directive

D. Reports:

The ADHC 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 Contract Adult Day Health Care Program (118E), STVHCS, 7400 Merton Minter Boulevard, San Antonio, Texas 78229 or reviewed by CADHC staff during facility visits.

E. 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.

VI.

ADMINISTRATIVE REQUIREMENTS AND PROCEDURES

A. 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 STVHCS, San Antonio, Texas, under this contract until authorizations are issued for ADHC services for specific beneficiaries. The STVHCS agrees to make payment on a timely basis for ADHC services rendered in accordance with such authorizations upon receipt of billings submitted by the Contractor’s ADHC facility at the completion of each month’s ADHC services.

B. Invoices:

1. Submission of Invoices: The Contractor shall submit weekly or monthly, by the fifteenth (15th) calendar day of each month, an invoice for services performed under the contract during the previous month. Invoices can be submitted using CMS 1500 form or electronic claim submission accepted by the VA. All invoices shall include the following information:

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

b. Invoice date.

c. Contract number or other authorizations for payment.

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

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

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

g. Invoices shall be submitted in arrears on a weekly or monthly basis.

h. Original red copy of CMS 1500 dated 02-12

*Unit Cost is the method of payment. A unit of authorized service is defined as half a day. One unit of service constitutes four hours of covered services provided by the

ADHC facility. Five hours or more of service constitutes two units of service. Time spent in approved transportation provided by the ADHC facility shall be counted in the unit of service.

2. Billings in Full: Invoices submitted by the Contractor to STVHCS for ADHC 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.

3. Absences of the patient from the ADHC facility will not be reimbursed.

C. Payment Address:

VA South Texas Health Care System

Fee/Claims Department San Antonio Fee Basis

Bonham, Texas 75418-0460

VII.

STVHCS RESPONSIBILITIES

A. Record-Keeping System:

1. Establishment/Maintenance: The Associate Chief of Staff, Geriatrics and Extended Care, or his/her designee, shall establish and maintain a record keeping system that will contain the following:

a. Date(s) when ADHC services were provided to VA beneficiaries and confirmation from Contractor of the date(s) ADHC services was performed.

2. Certification of Invoices: The STVHCS record keeping system shall be the basis of determining that services were received by the Government and certification of invoices for payment. Absences of the patient from the ADHC program will not be reimbursed.

B. Inspection:

1. Inspection Team: The STVHCS shall have the right to inspect the Contractor’s ADHC facility/program by an authorized representative(s) designated by the STVHCS 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.

2. 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 Contracting Officer 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.

C. Follow-Up Supervision Visits: Duly authorized representatives of the STVHCS shall provide follow-up supervision visits to veterans placed in the Contractor’s ADHC 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 ADHC program in any way of the responsibility for the daily care and medical treatment of the veteran.

D. Evaluation: The Government 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).

The Contractor shall appoint a Program Manager (at each adult day care covered by this contract) who shall be the contractor’s authorized representative for technical and administrative performance of all services required at that ADHC. 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 one week from referral. If this time frame is exceeded the ADHC will notify the STVHCS Contract ADHC Coordinator.

All clinical concerns regarding this contract will be forwarded to the Contract Adult day care Program Coordinator who is designated as the Contract Official Technical Representative.

B.1. 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.

B.2. Patients who require more than the level of care safe for ADHC will not be admitted or retained. The ADHC staff will notify the VA for direction.

B.3. The adult day care 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 adult day care shall neither require such segregated use by written or oral policies, nor tolerate such use by local custom.

B.4. The adult day care 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 adult day care warrants that subcontracting will not be resorted to as a means of circumventing this provision.

B.5. The adult day care 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 ADHC.

B.6. 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.

B.7. 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. Extensions of an authorization must be provided in writing by the placing VA Facility ten working days prior to the expiration of the existing authorization.

B.8. Contractors providing care will:

B.8.1. Admit patients to ADHC processing all required paperwork.

B.8.2. Utilize the nursing process in assessing, planning and implementing and evaluating patient care.

B.8.3. Manage the adult day healthcare plan for the veteran assuring that such care meets or exceeds State Licensing requirements.

B.8.4. 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.

B.8.5. The Contractor will assure that adequate staffing is available for the provision of care to meet the needs of the veterans.

B.8.6. The Contractor assures that the discharge plan is developed using appropriate resources to meet the veterans’ needs.

B.8. Required documentation. The following reports are required for the duration of the contract.

B.8.2. 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 Contract Adult Day Health Care or the Administrative Officer of the Day during non-business hours.

B.8.3. Any complaint made against the adult day care by the Veteran or his/her family will be forwarded to the contracting office within ten days of the complaint.

B.8.4. A complete copy of the Annual State Survey Report and any other reviewing agency report, including any and all responses to identified deficiencies will be forwarded to the contracting office within 15 days of receipt by the contracting agency.

B.8.5. A summary of quality management findings will be forwarded to the contracting office on a semi-annual basis (March and September) and submitted by the 15th of the following month.