_36C25725Q0034 Solicitation 2025.pdf

PAGE 1 OF 1. REQUISITION NO.

2. CONTRACT NO. 3. AWARD/EFFECTIVE DATE 4. ORDER NO. 5. SOLICITATION NUMBER 6. SOLICITATION ISSUE DATE

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. UEI: EFT:

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. NOV 2021)

PREVIOUS EDITION IS NOT USABLE Prescribed by GSA - FAR (48 CFR) 53.212

7. FOR SOLICITATION

INFORMATION CALL:

STANDARD FORM 1449

SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL PRODUCTS AND COMMERCIAL SERVICES

OFFEROR TO COMPLETE BLOCKS 12, 17, 23, 24, & 30

36C25725Q0034 01-01-2025

Michelle Cunningham, Contract Specialist 254-408-1652 12-31-2025

16:30 CST

Department of Veterans Affairs Network Contracting Office (NCO17) 1901 Veterans Memorial Dr. Building #171

Temple TX 76504

X

623110

$34 Million

Net 30 N/A

X

Department of Veterans Affairs Service Area Office West Network Contracting Office 17 1901 Veterans Memorial Dr. Building #171 Temple TX 76504

None

Department of Veterans Affairs Network Contracting Office (NCO17) 1901 Veterans Memorial Dr. Building #171

Temple TX 76504

Financial Services Center (FSC) Department of Veterans Affairs P.O. Box 149971 Austin TX 78714-8971

See CONTINUATION Page

The Government's intent for this Request for quote (RFQ), is to award multiple Indefinite Delivery Contracts (IDQ) under authority 38 U.S.C. § 1720 for Nursing Home Services all eligible Veterans within the Department of Veterans Affairs in various counties within the State of Texas as the as the need arises.

This open and continuous solicitation that will remain active as proposals are received. The first consideration will take place on 01.15.2025.

All awarded contracts from this solicitation will be used to award multiple indefinite-delivery contracts with facilities that meet the community nursing home requirements.

See 52.212-1 Instructions to Offerors for submittal and 52.212-2 Evaluation factors on pages 69 through 76.

Offerors are encouraged to ensure that they are registered in SAM.GOV prior to submitting their offer.

$0.00 See CONTINUATION Page

X

X 1

Francisco Mendoza Contracting Officer

36C25725Q0034

Table of Contents

SECTION A

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

AND COMMERCIAL SERVICES

SECTION B - CONTINUATION OF SF 1449 BLOCKS

B.1 CONTRACT ADMINISTRATION DATA

B.2 PRICE/COST SCHEDULE

ITEM INFORMATION

B.3 STATEMENT OF WORK…………………………………………………………………..6

SECTION C - CONTRACT CLAUSES

C.1 52.212-4 CONTRACT TERMS AND CONDITIONS—COMMERCIAL PRODUCTS

AND COMMERCIAL SERVICES (NOV 2023)

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

C.3 52.216-18 ORDERING (AUG 2020)

C.4 52.216-19 ORDER LIMITATIONS (OCT 1995)

C.5 52.216-22 INDEFINITE QUANTITY (OCT 1995)

C.6 52.217-8 OPTION TO EXTEND SERVICES (NOV 1999)

C.7 52.217-9 OPTION TO EXTEND THE TERM OF THE CONTRACT (MAR 2000) ... 34

C.8 52.222-55 MINIMUM WAGES FOR CONTRACTOR WORKERS UNDER

EXECUTIVE ORDER 14026 [DEVIATION (OCT 2023)] (JAN 2022)

C.9 52.237-3 CONTINUITY OF SERVICES (JAN 1991)

C.10 VAAR 852.201-70 CONTRACTING OFFICER'S REPRESENTATIVE (DEC 2022)

C.11 VAAR 852.203-70 COMMERCIAL ADVERTISING (MAY 2018)

C.12 VAAR 852.211-76 LIQUIDATED DAMAGES – REIMBURSEMENT FOR DATA

BREACH COSTS (FEB 2023) ALTERNATE I (FEB 2023)

C.13 VAAR 852.215-70 SERVICE-DISABLED VETERAN-OWNED AND VETERAN-

OWNED SMALL BUSINESS EVALUATION FACTORS (JAN 2023) (DEVIATION)

C.14 VAAR 852.215-71 EVALUATION FACTOR COMMITMENTS (OCT 2019)

C.15 VAAR 852.216-73 ECONOMIC PRICE ADJUSTMENT—STATE NURSING HOME

CARE FOR VETERANS (MAR 2018)

C.16 852.216-74 ECONOMIC PRICE ADJUSTMENT—MEDICAID LABOR RATES

(MAR 2018)

C.17 VAAR 852.222-70 CONTRACT WORK-HOURS AND SAFETY STANDARDS—

NURSING HOME CARE FOR VETERANS (MAY 2018)

C.18 VAAR 852.232-72 ELECTRONIC SUBMISSION OF PAYMENT REQUESTS

(NOV 2018)

C.19 VAAR 852.237-70 INDEMNIFICATION AND MEDICAL LIABILITY INSURANCE

(OCT 2019)

C.20 VAAR 852.237-74 NON-DISCRIMINATION IN SERVICE DELIVERY (OCT 2019)

C.21 MANDATORY WRITTEN DISCLOSURES

C.22 52.212-5 CONTRACT TERMS AND CONDITIONS REQUIRED TO IMPLEMENT

STATUTES OR EXECUTIVE ORDERS—COMMERCIAL PRODUCTS AND

COMMERCIAL SERVICES (MAY 2024)

SECTION D - CONTRACT DOCUMENTS, EXHIBITS, OR ATTACHMENTS

D.1 QUALITY ASSURANCE SURVEILLANCE PLAN……………………...……………...66

D.2 WAGE DETERMINATIONS……………………………………………………………. 66

D.3 RESOURCES UTILIZATION GROUPS (RUGs) IV DESCRIPTIONS…………...….67 D.4 RESOURCES UTILIZATION GROUPS (RUGs) III DESCRIPTIONS……………….67

D.5 COMBINED FEE SCHEDULE MEDICAID…………………………………………

SECTION E - SOLICITATION PROVISIONS

E.1 52.212-1 INSTRUCTIONS TO OFFERORS—COMMERCIAL PRODUCTS AND

COMMERCIAL SERVICES (SEP 2023)

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

1998)

E.3 52.204-24 REPRESENTATION REGARDING CERTAIN TELECOMMUNICATIONS

AND VIDEO SURVEILLANCE SERVICES OR EQUIPMENT (NOV 2021)

E.4 52.204-29 FEDERAL ACQUISITION SUPPLY CHAIN SECURITY ACT

ORDERS—REPRESENTATION AND DISCLOSURES (DEC 2023)

E.5 52.209-7 INFORMATION REGARDING RESPONSIBILITY MATTERS (OCT 2018)

E.6 52.216-1 TYPE OF CONTRACT (APR 1984)

E.7 52.233-2 SERVICE OF PROTEST (SEP 2006)

E.8 VAAR 852.233-70 PROTEST CONTENT/ALTERNATIVE DISPUTE RESOLUTION

(OCT 2018)

E.9 VAAR 852.233-71 ALTERNATE PROTEST PROCEDURE (OCT 2018)

E.10 VAAR 852.252-70 SOLICITATION PROVISIONS OR CLAUSES

INCORPORATED BY REFERENCE (JAN 2008)

E.11 52.212-2 EVALUATION—COMMERCIAL PRODUCTS AND COMMERCIAL

SERVICES (NOV 2021)

E.12 52.212-3 OFFEROR REPRESENTATIONS AND CERTIFICATIONS—

COMMERCIAL PRODUCTS AND COMMERCIAL SERVICES (MAY 2024)

SECTION B - CONTINUATION OF SF 1449 BLOCKS

Intentionally Blank

B.1 CONTRACT ADMINISTRATION DATA

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

a. CONTRACTOR: TBD

b. GOVERNMENT: Contracting Officer

Department of Veterans Affairs Network Contracting Office 17 / NCO 17 Regional Procurement Office-West (RPOW)

1901 Veterans Memorial Dr. Building #171 Temple, TX 76504

2. CONTRACTOR REMITTANCE ADDRESS: All payments by the Government to the contractor will be made in accordance with:

[X] 52.232-33, Payment by Electronic Funds Transfer—System For Award Management, or

[ ] 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. The Contracting Officer will schedule a post award orientation for contract orientation purposes as required by VA Acquisition Manual, Part M842.502-70.

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

AMENDMENT NO DATE

B.2 PRICE/COST SCHEDULE

Schedule tile and above the Item Information table.

ITEM INFORMATION

ITEM

NUMBE

R

DESCRIPTION OF

SUPPLIES/SERVICE

S

QUANTIT

Y

UNI

T UNIT PRICE AMOUNT

0001 1.00 YR ______________ ______________

Contractor to provide Community Nursing Home services in accordance with the Performance Work Statement.

Funding for this order will be executed via VA Form 1358 and payment will be in accordance with the fee schedule below.

Period of Performance is Base plus four Option year renewals.

Contract Period: Base POP Begin:

POP End:

PRINCIPAL NAICS CODE: 623110 - Nursing Care Facilities (Skilled Nursing Facilities) PRODUCT/SERVICE CODE: Q402 - Medical - Nursing Home Care Contracts

1001 1.00 YR ______________

Contractor to provide Community Nursing Home services in accordance with the Performance Work Statement.

Funding for this order will be executed via VA Form 1358 and payment will be in accordance with the fee schedule below.

Period of Performance is Base plus four Option year renewals.

Contract Period: Option 1 POP Begin:

POP End:

PRINCIPAL NAICS CODE: 623110 - Nursing Care Facilities (Skilled Nursing Facilities) PRODUCT/SERVICE CODE: Q402 - Medical - Nursing Home Care Contracts

2001 1.00 YR ______________ ______________

Contractor to provide Community Nursing Home services in accordance with the Performance Work Statement.

Funding for this order will be executed via VA Form 1358 and payment will be in accordance with the fee schedule below.

Period of Performance is Base plus four Option year renewals.

Contract Period: Option 2 POP Begin:

POP End:

PRINCIPAL NAICS CODE: 623110 - Nursing Care Facilities (Skilled Nursing Facilities) PRODUCT/SERVICE CODE: Q402 - Medical - Nursing Home

1.00 YR ______________ ______________

Contractor to provide Community Nursing Home services in accordance with the Performance Work Statement.

Funding for this order will be executed via VA Form 1358 and payment will be in accordance with the fee schedule below.

Period of Performance is Base plus four Option year renewals.

Contract Period: Option 3 POP Begin:

POP End:

PRINCIPAL NAICS CODE: 623110 - Nursing Care Facilities (Skilled Nursing Facilities) PRODUCT/SERVICE CODE: Q402 - Medical - Nursing Home Care Contracts

4001 1.00 YR ______________ ______________

Contractor to provide Community Nursing Home services in accordance with the Performance Work Statement.

Funding for this order will be executed via VA Form 1358 and payment will be in accordance with the fee schedule below.

Period of Performance is Base plus four Option year renewals.

Contract Period: Option 4 POP Begin:

POP End:

PRINCIPAL NAICS CODE: 623110 - Nursing Care Facilities (Skilled Nursing Facilities) PRODUCT/SERVICE CODE: Q402 - Medical - Nursing Home Care Contracts

GRAND TOTAL ______________

Contract Minimum guaranteed is $20,000.00 and Contract Maximum is the resulting contract Grand Value determined at time of award. The Government does not guarantee that it will place any orders under this contract in excess of the guaranteed minimum.

Contract Period of Performance is Base + 4 Option years.

B.3 PERFORMANCE WORKSTATEMENT

A. Overview

1. Federal Acquisition Regulation (FAR) – Indefinite Delivery Indefinite Quantity Contract (IDIQ). In accordance with FAR 16.504, Indefinite-Quantity

Contracts, this is an IDIQ with an ordering period of up to five years beginning from the date of award, with a 6-month option to extend at the sole discretion of the Government.

Location:

2. Services Rendered at VA Per Diem Rates. Upon acceptance of a VA patient by the CNH, if and when requested by the VA Contracting Officer or Ordering Officer when delegated, 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. VA is obligated only to the extent authorized if placement of patients is made in accordance with the terms specified in the IDIQ.

3. Ordering. Orders may be issued by Ordering Officers to place Veterans in Nursing Homes utilizing the CPRS system at VA hospital sites. The VHA Head of Contracting Activities (HCA) have approved the use of the VHA Facility Delegation of Authority - Medical Services (DOAMS) list of individuals or activities, as the approved ordering officer list for all nursing home IDIQ Contracts. No further written delegation is required. The DOAMS list designates the activities authorized to (1) place patients in CNH based on consult, (2) identify the individual patient care services, and (3) validate payments under the IDIQ utilizing Form 10-7078 Authorization and Invoice for Medical and Hospital Services.

4. Referrals to CNHs and placements. VA acknowledges that, depending on the availability of resources at a specific IDIQ holder facility at specific times, acceptance of a referral may be commercially impracticable for the IDIQ holder. Commercial or situational impracticability (e.g., facilities must be able to perform pre-admission screenings; assess whether the nursing home has beds open and appropriate beds;

are able to meet care needs based on number of staff and possess the clinical expertise to manage veterans care; have the appropriate room; can manage certain behaviors (like wandering if they don’t have a secure unit); and have the ability to decline based on criminal records, etc.) In that event, the IDIQ holder may decline to accept an authorization. If the IDIQ holder has determined that space is not available and will not accept the Veteran, the CNH program personnel will seek another IDIQ contract, and an authorization will be issued when a match is found.

B. Introduction

The Community Nursing Home (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 U.S. Department of Veterans Affairs Central Texas Veterans Health Care System (CTVHCS), in Temple, Texas 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.

C. Requirements

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 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, laboratory, x-ray, and other special services will be available at the same frequency as that provided to other residents at the nursing home receiving the same or comparable level of care. 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 CNH shall follow their own guidelines for Veteran routine care, behavioral issues, and medical emergencies. The per diem rate(s) established in this IDIQ will include the cost of restorative nursing care/therapy, physician visits to the nursing facility, initial costs of therapy evaluations/assessments, oxygen, rental equipment, primary medical care, one (1) provider visit per month and additional needed consultation, drugs (except for pre-approved medications that exceed 8.5% of the per-diem rate) 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. Nursing services, dietetic services, and social work services shall be performed in accordance with state laws and guidelines.

2. The contractor shall be required to provide the following:

a. Psychosocial Care.

b. Regular, modified, special, and supplemental diets; and enteral tube feeding formulas as ordered by the CNH physician.

c. Medical accessories and equipment. The contractor shall be required to provide items to ensure quality care. Brand name or types of medical accessories or equipment are not required.

1. Medical accessories include, but are not limited to: cannulas, tubes and masks.

2. Medical equipment includes, but is not limited to: wheelchairs, crutches, canes, portable oxygen tanks, mattresses, hospital-type beds, external pumps, oxygen concentrators, trapeze bars, and walkers. NOTE:

Described medical equipment covered under this contract is for communal use and is not patient specific. Other patient specific equipment needs will be handled in advance or on a case-by-case basis as soon as the equipment need is identified

d. Other services included in the all-inclusive daily per diem, include but are not limited to: hygienic care of the hair (including trimming male patient’s hair and facial hair) and regular laundry services (except dry cleaning).

e. The contractor must furnish to the veterans the basic personal need items that are essential in maintaining personal health hygiene and cleanliness.

Personal items included in the all-inclusive daily per diem. Include but are not limited to: toothbrush, toothpaste, shampoo, shaving cream, razors, blades if applicable, sanitary napkins, comb and/or hairbrush, soap, body lotion, denture adhesive and denture cleaner, facial tissues, and cloth or disposable adult diapers.

3. Special Services. When the contractor provides the following types of care, these additional requirements must be met.

a. HOSPICE: The contractor will provide full access to hospice when prescribed by the veteran’s primary care provider.

b. ALZHEIMERS/DEMENTIA CARE: Facilities with dementia special care units or providing specialized dementia care must be certified by the state as a dementia special care unit.

c. VENTILATOR CARE: The facility must be accredited by The Joint Commission for sub-acute care and State certified; and must meet all applicable standards. There must be 24-hour physician and respiratory therapist availability and 24-hour registered nurse on the unit. The following patient criteria for ventilator care apply: the patient no longer requires an acute hospital level of care, as determined by diagnostic testing; the patient has a feeding tube in place prior to admission; the patient has a tracheotomy prior to admission; the patient requires ventilation support 8 hours per day or more; and ventilator care is determined to be clinically appropriate.

d. SPINAL CORD: The contract facility must be willing to accept training and assistance from the VA Spinal Cord Team in assuring continuity of patient care. Patient specific care plans initiated in the Spinal Cord Injury Program will be continued in the long-term care setting.

e. PSYCHIATRIC/GEROPSYCHIATRIC CARE: Facilities providing locked units must meet state standards for such units including safety, restraints, and behavior modification programs.

f. ON SITE HEMODIALYSIS: Facilities providing on-site hemodialysis therapies must meet state standards and provide documentation of staff availability, training, and competencies to provide such care. When services are contracted, the contracted services must be duly licensed and accredited.

g. ON-SITE PERITONEAL DIALYSIS: Facilities providing on-site peritoneal dialysis therapies must have documentation of staff availability, training, and competencies to provide such care.

h. IV THERAPIES: The Nursing home will have documentation of staff availability, training and competency to provide such care. High-cost medication and administration supplies exceeding the per diem rate will be negotiated in advance on a case-by-case basis.

4. Contractors providing care will:

a. Any complaint made against the nursing home by the Veteran or his/her family, caregiver, or significant other will be forwarded to the COR within two days of the complaint.

b. A complete copy of the Annual State Survey Report and any other reviewing agency report, including all responses to identified deficiencies will be forwarded to the VA Social Work Administrative office, ATTN:

Contract Nursing Home Coordinator within 15 days of receipt by the contracting agency.

c. Facility will provide a copy of their facility quality measure indicator reports when requested by the CNH program.

d. Fax requested records to the VA within 48 hours of request.

e. Scan provider notes into patient records within 7 days after visit.

5.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.

6. 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.

7. Rate Basis

1. VA will utilize the appropriate Resource Utilization Grouping (RUG) rate(s) as a guide to determine VA rates. The VA rate will include the cost of 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 categories of care using Resource Utilization Groups as a reference or guide.

2. The Level of Care classification and associated per diem rates will remain in effect for each placement until and unless one of the following events takes place:

a. Re-hospitalization that may be associated with a change in level of care;

b. Need for more intensive therapy;

c. Significant change in condition; or

d. Classification changes may also occur based on a determination by VA.

e. 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, https://www.va.gov/vaforms/medical/pdf/VHA-10-7078-fill.pdf https://www.va.gov/vaforms/medical/pdf/VHA-10-7078-fill.pdf https://www.va.gov/vaforms/medical/pdf/VHA-10-7078-fill.pdf routine medications, laboratory, x-ray, therapy evaluations/assessments, and other special services authorized by VA, unless otherwise specifically exempted. VA will contract for appropriate Medicaid categories of care using Resource Utilization Groups as a guide. As with Medicare, a description of the systems can be found in 42 CFR Parts 409, et al. Assess patients using the Long-Term Care Minimum Data Set v 3.0 (or most recent version) on admission, day 14, quarterly, at discharge and with any significant change in health status including hospitalizations, or change in function, cognition, or affect, or at the end of authorized therapy and when the significant change in health status resolves.

8. 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 and will advise the facility on general matters of care and medical administration. 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).

9. Rehabilitation Criteria. All therapy provided under this IDIQ will be individual therapy, rather than group therapy, unless otherwise ordered by the authorizing VA facility. Therapy requires 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. Facilities providing skilled rehabilitation therapies must meet all Texas Department of Human Services RUG classification requirements for Medicaid/Medicare residents.

a. 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. Facilities providing skilled rehabilitation therapies (PT, OT, ST) at VA expense must provide documentation (weekly therapy evaluations and/or notes) that the therapies are being provided as ordered by a VA physician. The Veterans PACT provider, Inpatient PCP, Chief of GEC, or designee will approve the Rehabilitation plan of care prior to the placement and/or start of therapy.

b. 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. Facilities providing skilled rehabilitation therapies (PT, OT, ST) due to a change in condition after placement must have the veteran evaluated by the CNH physician who will document the need for such care. An initial rehabilitation evaluation and plan of care will be arranged either at the facility or through the VANTHCS’ Rehabilitation Service. The Veteran’s assigned PACT provider, Inpatient PCP, Associate Chief of Staff of GEC (ACOS), or designee will review the request and approve or deny it. If approved the veteran’s Rehabilitation plan of care isn’t to exceed 30 days. Approval for additional therapy(ies) after 30 days may be re-certified by the approving VA official based on the documentation. All therapies must be pre-approved, and an authorization will be sent with the dates approved by the COR or designee. A new MDS is required after patient has been discharged from therapy to reflect the change in services.

10. 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 the 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 Centralized Call Center is contacted by calling 844-724-7842, fax notification to 833-72HRVHA (833-724-7842), or send encrypted e-mail to VHAEmergencyNotification@va.gov within 72 hours of admission. This includes the cost of necessary transportation for such care.

The CNH Program needs to be notified within 24 hours of admission.

11. 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. All non-FAX forms of electronic exchange (for example, by e-mail) will require VA approved encryption of the data and additional approval from the VA Information Security Officer. The Contractor shall immediately report any violations mailto:VHAEmergencyNotification@va.gov of this security section to the COR. The COR will report any violations of this security section to the VA Privacy Officer and VA Information Security Officer immediately. Business associates must follow VHA privacy policies and practices when applicable. All contractors and business associates must receive privacy training annually.

12. Quality Expectations for CNH’s:

a. To participate in VA’s CNH Program, NHs are expected to have either 1) a three-star overall rating, or 2) a two-star overall rating with a four star or greater quality measures score on the Centers for Medicare and Medicaid (CMS) Nursing Home Compare Web site (https://www.medicare.gov/nursinghomecompare/search.html).

b. NHs with lower scores may participate in the CNH program only when specifically approved by the Deputy Under Secretary for Health for Operations and Management or designee.

c. All NHs in the CNH Program must be certified by CMS under Title XVIII (Medicare) or Title XIX (Medicaid) or have received special approval from the Office of Geriatrics and Extended Care (GEC) Office. NHs are responsible to the state of jurisdiction and CMS for the care provided. VA does not regulate the care or inspect CNHs. VA acts as an informed purchaser of care to purchase quality services for Veterans and enhance the Veterans’ experience in the home.

d. 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 Central Texas Veterans Health Care System CNH Program Coordinator at 254-534-3784. VA will monitor the professional care and administrative management of services provided to VA beneficiaries under this IDIQ (reference 7. a.).

(QASP Indicator #1) Access to CNH Quality of Care Reports. The CNH shall cooperate fully with VA’s quality improvement or quality assurance program functions relating to this IDIQ. VA will monitor the professional care and administrative management of services provided to VA beneficiaries under this IDC, through one or any combination of the following methods: reviews of State agencies report; on-site Annual Visit with CNH 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 IDC, including VA’s on-site monitoring. The VA Contracting Officer shall make all final determinations as to the Contractor’s reasonable cooperation with VA and compliance with these requirements.

13. 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 https://www.medicare.gov/nursinghomecompare/search.html 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.

12. 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 award. In addition, the CNH shall be in 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 IDIQ became effective. Ensure adherence to the following:

a. 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% sprinklered;

b. 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.

15. 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.

16. Re-admission to the VA Hospital and Emergency Care; Notification of Death of Veterans; CNH Responsibility for 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 notification is obtained. VA notification must be provided within 72-hours of admission of the patient to a non-Federal facility and notice of any veteran death within 24-hours. 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 IDIQ, 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 that authorized 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.

17. Leave of Absence (LOA). Therapeutic passes will be authorized by the CNH staff based on individual patient needs but are generally limited to two (2) times per month and should be pre-approved. 2 days/episode, pre-approved by VA when in the best interest of the Veteran and VA. Exceptions approved at VAMC level.

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 VA when the veteran returns to the facility so that a new authorization can be completed.

18. Reportable Events (QASP Indicator #4). VA requires CNHs to report to the CNH Coordinator or designee at VA any of the below events within 24-hours.

Reporting shall include date of occurrence and patient disposition and outcome.

a. Hospitalizations;

b. Change in status;

c. Medication changes due to change in condition;

d. Medication errors;

e. Sentinel events;

f. Falls with or without injury;

g. Immediately when there is a change of ownership (CHOW) of the CNH;

h. When there is a change of nursing home administrator or Director of

Nursing/Director of Nursing Service;

i. Abuse confirmed or under investigation of mistreatment, neglect, abuse or misappropriation of CNH veterans or property; exploitation of a veteran

j. Elopements of CNH veterans pursuant to state regulations;

k. Infectious outbreaks;

l. If the police are called for any reason related to a CNH Veteran;

m. When a resident returns to the facility from the hospital;

n. Death of a veteran, the hospice agency isn’t responsible for telling the VA;

o. Resident to resident or resident to staff altercations involving a CNH veteran with or without injury;

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

q. 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.

19. 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 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 from the subject CNH;

d. Not renew the IDIQ; and/or

e. Terminate the IDIQ.

20. VA Staff Access to CNH Records (QASP Indicator #5). All medical records concerning the veteran’s care in the CNH shall be readily accessible to VA. The CNH has 48 hours to provide requested documentation to VA staff. 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 (when there is no requirement in state law to retain longer) 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 with the CNH;

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

21. Specialty Services. The CNH will coordinate with the VA to arrange for routine specialty care for veterans. VA should be made aware as soon as possible to avoid a delay in care.

22. VA Health Care System Consultation/Resources.

(a) Telephone Care Communications Systems (TCCS): For urgent same-day outpatient specialty care or for non-urgent scheduled clinic appointments/consultations, phone number 254-981-0485 between 9 a.m. and 3 p.m. Monday through Friday, excluding holidays. If a same-day appointment is anticipated; please call as early as possible.

(b) Transportation: Necessary transportation to and from the VA hospital for clinics, evaluation or hospitalization will be arranged and paid by the VA hospital for CNH patients when requested. Transportation must be pre-approved.

When a Veteran beneficiary is sent to an outpatient appointment at the VA or community outpatient clinic (or admission exam where admission is not a certainty), the Veteran beneficiary is still considered a resident of the Contractor’s facility and thereby remains the Contractor’s responsibility.

The Contractor shall make a judgment as to whether the Veteran beneficiary needs physical assistance due to disability or oversight due to confusion.

The Contractor shall provide adequate oversight during the trip to the VA or while in the outpatient clinic. This oversight can be provided by a family member, clergy person, volunteer, or any other person who in the Contractor’s judgment can responsibly and capably provide the necessary oversight. In the absence of any other person, the Contractor shall send a staff member to assure protective oversight of the Veteran beneficiary.

The Contractor shall provide oversight and protection to the Veteran beneficiary including but not limited to, providing sack meals for the beneficiary who may have an appointment time that is expected to overlap the beneficiary’s scheduled mealtime.

23. 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.

24. 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 designated VA Staff regarding any change in Veteran status: discharge, transfer, discharge 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. MDS Sections A & Z covering the entire billing period supporting the level of care category must accompany each invoice. Failure to include this information may result in delayed payments.

a. Pre-approved 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.

b. High-cost drugs: All requests for additional reimbursement for high-cost drugs (medication costs that exceed 8.5% of per-diem) must be negotiated in advance on a case by case basis. Corresponding billing (if applicable) is due as soon as possible, but no later than 90 calendar days after use of products.

c. 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.

d. Minimum Data Set (MDS): The facility will complete an MDS on day 5, 14 , 30 and 90 days after admission or after a hospitalization that resulted in a change of condition then every 90 days after the initial 90 days; or when there is a change of condition, or change in function, cognition, or affect, or at the end of authorized therapy period. If a new MDS is completed for a change in condition, a new one needs to be completed when the change is resolved. For example, an MDS might be completed due to a new wound; a new MDS needs to be completed when the wound resolves even if it’s before the next MDS is due. Facility will provide copies of the MDS when requested by the CNH Program. A current MDS covering the entire billing period supporting the level of care category must accompany each invoice. If the recipient is discharged from the VA CNH Program and subsequently qualifies for a new admission, the MDS documentation requirements start over (5 days, 14 days, 30 days, 90 days and quarterly thereafter).

25. Minimum Quantities; VA Payment. It is impossible to determine the exact or estimated amount, which will be expended under this IDIQ.