36C25919Q0280-004.docx

36C25919Q0280

FedBizOpps Combined Synopsis/Solicitation Notice

CLASSIFICATION CODE

SUBJECT

CONTRACTING OFFICE'S

ZIP-CODE

SOLICITATION NUMBER

RESPONSE DATE (MM-DD-YYYY)

ARCHIVE

DAYS AFTER THE RESPONSE DATE

RECOVERY ACT FUNDS

SET-ASIDE

NAICS CODE

CONTRACTING OFFICE

ADDRESS

POINT OF CONTACT

(POC Information Automatically Filled from User Profile Unless Entered)

DESCRIPTION

See Attachment

AGENCY'S URL

URL DESCRIPTION

AGENCY CONTACT'S EMAIL

ADDRESS

EMAIL DESCRIPTION

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POSTAL CODE

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ADDITIONAL INFORMATION

GENERAL INFORMATION

PLACE OF PERFORMANCE

* = Required Field FedBizOpps Combined Synopsis/Solicitation Notice Rev. March 2010 Q Montana Community Nursing Home – Gallatin County 80111 36C25919Q0280 04-23-2019 N 623110 Department of Veterans Affairs Network Contracting Office

NCO 19

6162 South Willow Drive, Suite 300 Greenwood Village CO 80111 Concesa Hubbard concesa.hubbard@va.gov Montana 59715

USA

concesa.hubbard@va.gov The Fort Harrison Veterans Affairs Medical Center (VAMC) has a requirement for Community Nursing Home (CNH) in Gallatin County, Montana. The proposed action is for a Firm-fixed purchase order of a base year and a 12 months option. The CNH contractors shall be responsible for providing medical care and rehabilitative services.

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.

DUNS:

DUNS+4:

PHONE:

FAX:

17b. CHECK IF REMITTANCE IS DIFFERENT AND PUT SUCH ADDRESS IN OFFER 18b. SUBMIT INVOICES TO ADDRESS SHOWN IN BLOCK 18a UNLESS BLOCK BELOW IS CHECKED

SEE ADDENDUM

19.

20.

21.

22.

23.

24.

ITEM NO.

SCHEDULE OF SUPPLIES/SERVICES

QUANTITY

UNIT

UNIT PRICE

AMOUNT

(Use Reverse and/or Attach Additional Sheets as Necessary)

25. ACCOUNTING AND APPROPRIATION DATA

26. TOTAL AWARD AMOUNT (For Govt. Use Only) 27a. SOLICITATION INCORPORATES BY REFERENCE FAR 52.212-1, 52.212-4. FAR 52.212-3 AND 52.212-5 ARE ATTACHED. ADDENDA

ARE

ARE NOT ATTACHED.

27b. CONTRACT/PURCHASE ORDER INCORPORATES BY REFERENCE FAR 52.212-4. FAR 52.212-5 IS ATTACHED. ADDENDA

ARE

ARE NOT ATTACHED

28. CONTRACTOR IS REQUIRED TO SIGN THIS DOCUMENT AND RETURN _______________

29. AWARD OF CONTRACT: REF. ___________________________________ OFFER

COPIES TO ISSUING OFFICE. CONTRACTOR AGREES TO FURNISH AND

DATED ________________________________. YOUR OFFER ON SOLICITATION

DELIVER ALL ITEMS SET FORTH OR OTHERWISE IDENTIFIED ABOVE AND ON ANY

(BLOCK 5), INCLUDING ANY ADDITIONS OR CHANGES WHICH ARE

ADDITIONAL SHEETS SUBJECT TO THE TERMS AND CONDITIONS SPECIFIED

SET FORTH HEREIN IS ACCEPTED AS TO ITEMS:

30a. SIGNATURE OF OFFEROR/CONTRACTOR 31a. UNITED STATES OF AMERICA (SIGNATURE OF CONTRACTING OFFICER) 30b. NAME AND TITLE OF SIGNER (TYPE OR PRINT) 30c. DATE SIGNED 31b. NAME OF CONTRACTING OFFICER (TYPE OR PRINT) 31c. DATE SIGNED

AUTHORIZED FOR LOCAL REPRODUCTION

(REV. 2/2012)

PREVIOUS EDITION IS NOT USABLE

Prescribed by GSA - FAR (48 CFR) 53.212

7. FOR SOLICITATION

INFORMATION CALL:

STANDARD FORM 1449

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

SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL ITEMS

00001 36C25919Q0280 04-18-2019 Concesa Hubbard 303-712-5774 04-23-2019

1:00 PM MT

36C259 Department of Veterans Affairs Network Contracting Office

NCO 19

6162 South Willow Drive, Suite 300 Greenwood Village CO 80111 X 623110 $27.5 Million X N/A X Department of Veterans Affairs Montana VA Health Care System 3687 Veterans Drive P.O. Box 1500 Fort Harrison MT 59636-1500 36C259 Department of Veterans Affairs Network Contracting Office

NCO 19

6162 South Willow Drive, Suite 300 Greenwood Village CO 80111

Department of Veterans Affairs HCBS/CNH Program PO Box 1500, Mail Code 182H Fort Harrison, MT 59636-1500 Invoices shall be mailed or FAX'd.

888-795-0773 See Page 4 for details.

Purchase Order for Community Nursing Homes (CNH) for Montana VA Health Care System in accordance with the Performance Work Statement. This is a base year of 12-months and one 12-months option period.

Period of Performance is:

Base: 05/1/2019 - 04/30/2020 Option: 05/1/2020 - 04/30/2021 X X X David J. Medina

Table of Contents

SECTION B - CONTINUATION OF SF 1449 BLOCKS

B.1 CONTRACT ADMINISTRATION DATA

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

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

a. CONTRACTOR:

TBD

b. GOVERNMENT:

Concesa Hubbard (Contract Specialist) Department of Veterans Affairs Network Contracting Office 19 6162 South Willow Drive, Suite 300 Greenwood Village, CO 80111

Concesa.Hubbard@va.gov Telephone No. 303-712-5774

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

3. INVOICES: Invoices shall be submitted 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.

a. All invoices and supporting documentation will be sent via fax, secure email or mailed to:

Fax: 406-447-7645 Via Email: deetta.hurt@va.gov

Department of Veterans Affairs HCBS / CNH Program PO Box 1500, Mail Code 182H Fort Harrison, MT 59636-1500

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

Page 1 of Page 1 of Page 1 of Page 1 of

B.2 PRICE SCHEDULE: RESOURCE UTILIZATION GROUPS (RUG) IV

Bridger Healthcare Effective Date of Medicaid Rate___________________________________________

ADD-ON PERCENTAGE

= VA Base

BB2, BB1, BA2, BA1, PE2, PE1, PD2, PD1, PC2, PC1, PB2, PB1, PA2, PA1

ADD-ON

PERCENTAGE

TOTAL PER DIEM

RATE

CE2, CE1, CD2, CD1, CC2, CC1, CB2, CB1, CA2, CA1

LE2, LE1, LD2, LD1, LC2, LC1, LB2, LB1

HE2, HE1, HD2, HD1, HC2, HC1, HB2, HB1

ES3, ES2, ES1

Ultra-high Rehab - RUC, RUB, RUA Very-high Rehab - RVC, RVB, RVA High Rehab – RHC, RHB, RHA Medium Rehab – RMC, RHB, RHA Low Rehab – RLB, RLA

Ultra-high Rehab + Ext Svs – RUX, RUL Very-high Rehab + Ext Svs – RVX, RVL High Rehab + Ext Svs – RHX, RHL Medium Rehab + Ext Svs – RMX, RML Low Rehab + Ext Svs – RLX

* Note: “The ‘specified’ rates under this Purchase Order will be those rates in effect under the contract each time an option is exercised under the option clauses, 52.217-8 or 52.217-9.”

**Note: “The evaluation of options under FAR 52.217-8 will be accomplished by using the prices offered for the last option to determine the price for a 6-month option period, which will be added to the base and other option years to arrive at the total price. Evaluation of options will not obligate the Government to exercise the option(s).

MEDICAID RATE DETERMINATION

The per diem rate is established by the current Medicaid rate for Medicaid approved nursing homes plus an add-on percentage to cover the cost of supplies, services, and equipment above that provided under Medicaid established by the local State Medicaid Agency (SMA). Any Medicaid rates established after the effective date of this IDC will constitute a modification to the IDC. VA will use Medicaid rates for room, board, and routine nursing care. For all levels of nursing care, a percentage is added for routine ancillary services/supplies, such as medications, nursing supplies, oxygen (occasional use), x-ray, laboratory, physician visits, and rental equipment. Special equipment, e.g. clinitron bed, is/are not considered routine ancillary services (and may be provided by the VA).

Medication costs which comprise more than eight and one-half percent (8.5%) of the per diem rate are generally, not considered routine ancillary supplies (and may be provided by the VA).

Rehabilitation therapies will be provided as a distinct level of care. Hospice Care and Dialysis are not included in the rate. VA or other payers may be used for Hospice and Dialysis, as determined by the veteran with VA approval.

MEDICAID RATE ADJUSTMENTS

Medicaid rate adjustments may be requested by CNH and/or the Contractor’s authorized Community Nursing Home (CNH) representative during the term of this IDC. Request for Medicaid rate adjustments must be accompanied by a copy of the state Medicaid rate on state letter head. If approved, the contract will be modified and signed by both the Contractor and the VA Contracting Officer. The effective date of the Medicaid rate adjustment will be the actual “Effective Date” as indicated on the IDC or the modification based on the date the Medicaid request was submitted to the Contracting Office. There will be no retroactive payments if a Medicaid letter rate adjustment is requested and the date of the letter is prior to the date of the request.

B.3 PERFORMANCE WORK STATEMENT (PWS)

1. Background/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 Montana Health Care System in Fort Harrison, Montana at the prices specified in the section titled Schedule of Items of this contract. Nursing home facilities in the CNH program shall cooperate with VA staff in referral of appropriate veterans for care and accept veterans of which they have the capability/capacity to care. The term, “facilities,” shall include but not be limited to rooms, wards, sections, eating areas, drinking fountains, entrances, and other like areas. VA shall have the right to inspect the CNH and all appurtenances by authorized VA representative(s) to ensure that acceptable standards are maintained and that the necessary care to maintain the well-being of the patient is rendered.

2. General. Nursing home facilities in the CNH program shall ensure that care meets the health needs and promotes the maximum well-being of VA patients. Nursing home care will be furnished to ensure the total medical, nursing, and psychosocial needs of VA beneficiaries. All nursing home facilities in VA’s CNH program must have current Center for Medicare and Medicaid Services (CMS) certification (Medicare and/or Medicaid) and a State nursing home license. VA developed quality of care standards utilizing CMS inspection criteria that are followed by VA in its selection of nursing homes which includes exclusionary criteria on which the CNH is evaluated. See VHA Handbook 1143.2, “VHA Community Nursing Home Oversight Procedures (June 4, 2004) a copy of which is available at: http://www.va.gov/vhapublications/publications.cfm?pub=2. VA often has a particular need for specialty care services in the CNH program. The VA requires CNHs to have bed capacity to ensure their ability to take referrals when requested. The CNH also must be able to accept VA referrals in a timely fashion (ideally within 24 hours of request). CNH provider visits will be available at the rate of one (1) visit per month. Laboratory, x-ray, and other special services will be available to VA patients as needed. In addition, the care provided will include room, meals, nursing care, and other services or supplies-to include continuous oxygen- commensurate with the VA-authorized level of care, without extra charge. Duly authorized representatives of VA will provide quality oversight visits to veterans placed to assure continuity of care and to assist in the veterans’ transition back into the community. These visits do not substitute nor relieve the CNH in any way of the responsibility for the daily care and medical treatment of the veteran. The per diem rate(s) established in this contract will include the cost of primary medical care, one (1) CNH provider visit per month and needed consultation, drugs and routine supplies, laboratory, x-ray, and other special services authorized by VA, unless otherwise specifically excepted (see Schedule of Items in this contract 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.

3. Services Rendered at VA Per Diem Rates. Upon acceptance of a VA patient by the CNH, if requested by the VA Contracting Officer or authorized representative, the Contractor shall furnish all supplies and services herein described. VA is obligated only to the extent authorized placement of patients is made in accordance with this PWS.

4. 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.

5. VA Authorizations. Authorization for CNH care will be submitted on VA Form 10-7078, “Authorization and Invoice for Medical and Hospital Services,” or other electronic format used by the VA. 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.

6. Patient Placement. The CNH Coordinator/Social Worker (Contracting Officer Representatives (COR)/or Point of Contact (POC)) will coordinate the placement of patients to the Nursing Homes utilizing the Computerized Patient Record System (CPRS) system at VA hospital sites (Reference FAR 16.505 (b)(2)(i)(B)). COR/POC Contact information is as follows:

Address

Montana Health Care System

Telephone number

(406) 447-6714

E-mail address

Bridget.McGregor@va.gov

Facsimile number

(406) 447-7645

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

7. VA acknowledges that, depending on the availability of resources at specific CNH facilities at specific times, acceptance of a referral may be commercially impracticable for the CNH.

8. Designated VA CNH program personnel will issue written authorizations for Veterans to the contracted CNH. The determination to place a Veteran at a CNH is based on program needs determined by the VA.

9. Medicaid-Based Rates. The current State Medicaid rates on State letter head may be used as a basis for determination of VA rates. The VA rate will include medical care, routine medications, laboratory, x-ray, therapy(ies), and other special services authorized by VA, unless otherwise specifically exempted. As with Medicare, a description of the RUG-IV systems can be found in 42 CFR Parts 409, et al.

10. Primary Medical Coverage. The assigned CNH provider is the primary medical provider during the CNH stay and is responsible for writing or approving admission and all other orders as soon as the veteran arrives at the CNH. The CNH provider is responsible for general medical care, urgent evaluation and intervention. Provider visits will be according to the Center for Medicare and Medicaid Services (CMS) guidelines. The assigned CNH 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).

11. Rehabilitation Criteria. All therapy provided under this PWS will be individual therapy, rather than group therapy, unless otherwise ordered by the authorizing VA facility. Therapy will require pre-approval by VA before services are provided. Medical Restorative criteria will be used for physical therapy, occupational therapy, and speech therapy. Therapy must be skilled, relate to safety and be restorative according to Medicare criteria.

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. 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. The Contractor shall submit all Progress Reports to the VAMC.

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.

12. Emergency Care; Financial Responsibility; Advanced Directives. In emergencies, CNH staff will utilize the 911 local emergency systems as for any resident. Advance directives or living wills shall be adhered to according to CNH physician’s orders. When private hospitalization or emergency services are required, the patient, spouse, financial guardian or insurer is financially responsible. Service connected disabled veterans may qualify for VA coverage of emergency care provided the VA Health Care System (VAHCS) is contacted by the private hospital provider within 72-hours of admission on the first business day following a weekend or holiday. This includes the cost of necessary transportation for such care.

13. 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 if they are conducting health care on VA’s behalf. The CNH care program qualifies as a medical service, so no BAA is required.

14. State Licensure; Access to CNH Quality of Care Reports (Performance Objective #1). The CNH must maintain a current and unrestricted state license to operate as a skilled nursing facility. Changes in the status of the licensure will be immediately reported to the VA Home and Community Care Department and the Contracting Officer. VA will monitor the professional care and administrative management of services provided to VA beneficiaries under this contract, through one or any combination of the following methods: reviews of State agencies reports; on-site inspection of the CNH by VA staff; and/or on-site monitoring of VA patients. The CNH shall provide VA with copies of all State agency reports when requested, and cooperate fully with VA’s quality improvement or quality assurance program functions relating to this contract, including VA’s on-site inspection and monitoring. The VA Contracting Officer shall make all final determinations as to the Contractor’s reasonable cooperation with VA and compliance with these requirements.

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

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

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

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

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

e. Provide dates when corrective action will be completed.

16. 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) and remain in compliance with all applicable Federal, State and local regulations. The administrator of the CNH is required to notify the VA Contracting Officer and COR/POC 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. The VA Contracting Officer or COR/POC will notify the VA Safety Manager responsible for the Life Safety Code inspection of the CNH and he/she will review (inspect the facility if required) the proposed changes and provide necessary approval or disapproval of the CNH to house veterans during and/or after the proposed changes. These changes may include but are not limited to:

a. Interior changes requiring VA approval. Some examples of facility changes that require the VA Contracting Officer/COR/POC notification are as follows: interior finish, corridor partitions/walls, patient room doors, linen or trash chutes, exits, emergency lighting, fire alarm systems, automatic sprinklers, smoke barrier walls or doors, oxygen systems, compressed gas storage, HVAC, electrical and fuel gas systems;

b. Automatic sprinkler system. All VA contracted CNH facilities are to be fully-equipped with a fully-automatic sprinkler system installed in accordance with the National Fire Protection Association’s (NFPA) standards and be 100% sprinklered;

c. Natural disasters. In the event of a natural disaster (flood, tornado, etc.), the CNH shall communicate all action plans to Fort Harrison Health Care System in Fort Harrison, Montana. The action plans will at a minimum identify temporary transfers of location, dates, and names of veterans transferred; and

d. Major construction; additions; and renovations. Major construction including building additions or other renovations which may affect physical plant integrity; SHALL MEET latest NFPA 101 Life/Safety Code requirements as well as any additional VA CNH construction standards in place at time of renovation or alteration.

17. Acceptable Safety and Sanitation Practices. Acceptable safety and sanitation practices shall be observed throughout the CNH 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.

18. Re-admission to the VA Hospital and Emergency Care; Notification of Death of Veterans; CNH Responsibility to Veteran’s Belongings or Personal Effects (Performance Objective #3). VA beneficiaries who begin to require more than the level of care authorized by VA will be readmitted to an appropriate VA facility, as determined and authorized by VA.

a. When such an admission is not feasible because of the nature of the emergency, hospitalization in a non-Federal facility may be accomplished provided VA authorization is obtained. VA authorization must be obtained within 72-hours of admission of the patient to a non-Federal facility and notice of any veteran death within 24-hours or immediately the first business day after a weekend or holiday. If hospitalization of a non-emergency nature is required, readmission to a VA Medical Center may be accomplished as soon as the patient’s condition is sufficiently stabilized to permit admission to a VA Medical Center.

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

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

19. Leave of Absence (LOA) – Bed-Hold Statement. For re-hospitalizations or therapeutic passes, VA will pay a bed hold. Therapeutic passes will be authorized by the CNH staff based on individual patient needs, but are limited to 6 overnights per calendar year, typically at 24-48 hours per each event and will be pre-approved. VA will cover bed holds based on the following plan:

a. VA will reimburse according to the prevailing State Medicaid guidelines.

Bed-hold will begin the date the resident leaves the CNH and full per diem will resume on the date of readmission to the CNH. Absences of fifteen (15) consecutive calendar days or more, whether in a VA or in a non-Federal facility require a new authorization. The CNH is responsible to notify the family if a bed hold is required for a longer period. The family would then make arrangements with the home to hold the bed.

20. Reportable Events (Performance Objective #4). VA requires CNHs to report to the CNH Coordinator/COR/POC at VA any of the following events within 24-hours or immediately the first business day after a weekend or holiday:

a. Sentinel events;

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

c. When there is a change of CNH administrator or Director of Nursing/Director of Nursing Service;

d. substantiated allegations of mistreatment, neglect, abuse or misappropriation of CNH veterans or property;

e. Elopements of CNH veterans pursuant to state regulations;

f. Infectious outbreaks;

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

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

i. 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:

a. A fall resulting in death or injury;

b. Elopement resulting in a missing patient;

c. Patient abuse confirmed or under suspicion;

d. A medication error resulting in patient illness or injury;

e. Death or patient injury related to restraint (including side rails) use; or

f. Death related to an unconfirmed or suspicious cause.

When an adverse event occurs involving a CNH Veteran which is not determined to be a Sentinel Event (but that the State requires that the occurrence be reported to the State), such event is also to be reported to VA’s CNH program office. Some adverse events, such as minor medication errors without catastrophic outcomes, are managed by the CNH in the context of their quality improvement programs. It is not necessary for CNHs to report such incidents to the CNH program office.

21. 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 identified through the Exclusion Review, the Government will take one or more of the following actions in accordance with the terms and conditions of the PURCHASE ORDER 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 PURCHASE ORDER from the subject CNH;

d. Not renew the PURCHASE ORDER; and/or

e. Terminate the PURCHASE ORDER.

22. VA Staff Access to CNH Records (Performance Objective #5). The Contractor shall ensure that all medical records concerning the veteran’s care in the CNH will be readily accessible to VA. Upon discharge or the death of a patient, medical records will be retained by the CNH for a period of at least five (5) years following termination of care. Patient records will be maintained in conformance with the Privacy Act of 1974 (5 U.S.C. § 552a). The contractor shall maintain a medical record 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 and Invoice for Medical and Hospital Services (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 the CNH;

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

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

24. VA Health Care System Consultation/Resources. If emergency hospitalization is needed after evaluation by the CNH physician, contact VA at 406-447-6119 request OBMT to speak to MOD (physician on duty) to determine feasibility of transfer to VA Hospital. All other ER visits and/or hospitalizations are to be reported to VA NAO office at 1-888-795-0773. A message may be left after hours and on weekends.

25. 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.

26. CNH Billing (Performance Objective #6). Invoices for board, care and ancillary services shall be submitted promptly to the authorizing facility by the 15th calendar day following the end of the month in which services were rendered. The CNH will promptly notify the VA CNH Coordinator regarding any change in Veteran status: discharge, transfer, against medical advice (AMA), hospitalization, death and/or any changes in payer source and any ability to complete timely billing. All invoices must include the full name and address of the CNH and shall reflect the patient’s name, social security number, number of days billed, RUG category(ies), and agreed upon RUG rate (s). Failure to include this information may result in delayed payment. The current CNH Billing Cover Sheet can be obtained from the VA National Payment Center at 1-888-795-0773.

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: The CNH will notify immediately of any high cost medications for contract veterans. VA will review the medication and may decide to provide the medication directly to the CNH. All requests for additional reimbursement for high cost drugs and corresponding billing are due as soon as possible, but no later than 90 calendar days after use of products. Invoices for pharmacy reimbursement will be sent directly to Social Work Service at Montana Health Care System.

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.

· National Payment Center Claim Status Hotline, 1-888-795-0773 Option 2

· VA Payment Inquiry Website, https://www.vis.fsc.va.gov

· VA electronic EOB website, https://www.vahcps.fsc.va.gov

27. Authorization for Patient Care: It is impossible to determine the exact or estimated amount, which will be expended by the CNH. No obligation will be incurred by VA until authorizations are issued for CNH care of specific beneficiaries. VA agrees to make payment on a timely basis for services rendered in accordance with such authorizations upon receipt of proper invoices submitted by the CNH as outlined in this PURCHASE ORDER. VA will make payment for the day a recipient enters the CNH but not the day the recipient leaves a CNH unless entrance and departure are on the same day, then payment will be made for one (1) day.

28. VA Payments. Payments made by VA under any contract constitute the total cost of CNH care. No additional charges will be billed to Medicare (with the exception of hospice), Medicaid, or private insurance, the beneficiary or his/her family, either by the CNH or any third party furnishing services or supplies required for such care, unless and until specific prior authorization in writing is obtained from the VA facility authorizing placement. The patient, family and any other entitlement programs (e.g., Medicare, Medicaid, etc.) will not be billed for uncovered services or costs during the VA contract period. This constitutes double-billing and Federal fraud.

b. Contractors who bill electronically using the HIPAA-compliant claims transactions must submit claims through the VA clearinghouse, Emdeon, using payer ID number 12115 for medical claims.

c. Contractors who are not able to use the HIPAA-compliant transactions are not required to do so. All invoices and supporting documentation will be sent via fax, secure email or mailed to:

Fax: 406-447-7645 Via Email: deetta.hurt@va.gov

Mail to:

Department of Veterans Affairs HCBS / CNH Program PO Box 1500, Mail Code 182H Fort Harrison, MT 59636-1500

Please include a screenshot of the MDS page that shows the RUGS scores to ensure the proper contract rate is being utilized. Any information transmitted via email, such as personal information including Social Security numbers and date of birth should only be sent via secure mail.

d. Do not send any invoices to the Network Payment Center (NAO). The medical centers will review the invoices and forward to the NAO for payment once the information has been reviewed and payment is authorized and then sent to treasury for payment. Invoices after 01 October that are sent to the NAO will be returned for submission to the Medical Center. Please call 1-888-795-0773 for all payment inquiries and claim status. Please provide the following information: patient name, full SSN, referring VAMC name, dates of service for the care, and their billing name on file with the VA. For all outstanding claims before 10/01/18, please send an email to Tera.Laughlin@va.gov. Any supporting documents not faxed should be mailed to: DeEtta Hurt, Department of Veterans Affairs, HCBS / CNH Program, PO Box 1500, Mail Code 182H, Fort Harrison, MT 59636-1500.

29. Private Rooms. A private room rate for clinical concerns such as communicable diseases or infections (e.g., MRSA, VRE), or other pertinent clinical needs may be charged above the negotiated RUG rate for that facility with prior approval by the VA CNH Coordinator or designated VA staff. However, no additional private room charge will be allowed in the following circumstances: where the CNH only maintains private rooms; no double-occupancy rooms are available; and for ventilator-dependent patients with prior-negotiated rates.

30. Specialized Prosthetics Equipment (e.g., specialty bed): Veterans may be eligible for specialized equipment when clinically indicated. Pre-approval required by VA.

Medications: All Medications administered to VA-contracted Veterans residing in a CNH will be charged at the Average Wholesale Price (AWP) or according to the pharmacy bill, whichever is less. Medication costs up to 8.5% of billed care are included in the RUG rate pricing. Medication costs which exceed 8.5% of the monthly per diem will be billed as a separate line item in addition to the applicable RUG rate(s). All calculations will be made on a monthly basis. When a patient’s medication costs are determined to be in excess of the 8.5%, the VA must be promptly alerted to establish an appropriate course of action. This course of action may include the VA providing medication(s) to the CNH for the contracted Veteran or requiring an acceptable alternative medication be substituted. If for any reason the VA provides patient medications, the rate of reimbursement will be decreased by an agreed upon amount. The VA also reserves the right to deny payment for medication, which at its sole discretion, is determined by the VA to be of no clinical benefit to the veteran.

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B.4 DELIVERABLES

REPORTS

These reports are required to be submitted by the Contractor. The definitions below outline the timeframe for submission of reports directly to the CNH Coordinator:

Daily* – no later than 24 hours after notification of event.

Monthly – due to the CNH Coordinator no later than the 15th workday of the month following the previous month.

Quarterly – due to the CNH Coordinator no later than the 15th of the month following the reporting quarter – reporting quarters are based on our fiscal year, October to December, January to March, therefore reports are due by January 15th, April 15th, etc.

Annual – due to the CNH Coordinator no later than the end of your Period of Performance.

Fax- shall be sent via secure fax.

Emails- shall not contain patient information unless sent encrypted.

* While these are labeled as “daily”, they are only reported when applicable. If an incident occurs and the contractor has 48 hours to report, then this would be reported on the daily report in which the 48 hours falls.

Daily Reports (As Required)

Annual Reports

and the CO

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B.5 IT CONTRACT SECURITY

VA INFORMATION AND INFORMATION SYSTEM SECURITY/PRIVACY

1. GENERAL

Contractors, contractor personnel, subcontractors, and subcontractor personnel shall be subject to the same Federal laws, regulations, standards, and VA Directives and Handbooks as VA and VA personnel regarding information and information system security.

2. ACCESS TO VA INFORMATION AND VA INFORMATION SYSTEMS

a. A contractor/subcontractor shall request logical (technical) or physical access to VA information and VA information systems for their employees, subcontractors, and affiliates only to the extent necessary to perform the services specified in the contract, agreement, or task order.

b. All contractors, subcontractors, and third-party servicers and associates working with VA information are subject to the same investigative requirements as those of VA appointees or employees who have access to the same types of information. The level and process of background security investigations for contractors must be in accordance with VA Directive and Handbook 0710, Personnel Suitability and Security Program. The Office for Operations, Security, and Preparedness is responsible for these policies and procedures.

c. Contract personnel who require access to national security programs must have a valid security clearance. National Industrial Security Program (NISP) was established by Executive Order 12829 to ensure that cleared U.S. defense industry contract personnel safeguard the classified information in their possession while performing work on contracts, programs, bids, or research and development efforts. The Department of Veterans Affairs does not have a Memorandum of Agreement with Defense Security Service (DSS). Verification of a Security Clearance must be processed through the Special Security Officer located in the Planning and National Security Service within the Office of Operations, Security, and Preparedness.

d. Custom software development and outsourced operations must be located in the U.S. to the maximum extent practical. If such services are proposed to be performed abroad and are not disallowed by other VA policy or mandates, the contractor/subcontractor must state where all non-U.S. services are provided and detail a security plan, deemed to be acceptable by VA, specifically to address mitigation of the resulting problems of communication, control, data protection, and so forth. Location within the U.S. may be an evaluation factor.

e. The contractor or subcontractor must notify the Contracting Officer immediately when an employee working on a VA system or with access to VA information is reassigned or leaves the contractor or subcontractor's employ. The Contracting Officer must also be notified immediately by the contractor or subcontractor prior to an unfriendly termination.

f. Contractor shall secure and provide file plan for veterans records associated with care (30 days after contract award). Secure shall mean the contractor has implemented physical measures, policies, and procedures to protect the contracted entity’s electronic and physical records, from natural and environmental hazards, as well as unauthorized intrusion pertaining to veterans. File plan shall include at a minimum “location of file”, “date of admission”, and “date of discharge”.

g. Contractor shall adhere to Records Control Schedule 10-1 dated May 2016 for classification, retention, and disposals of records pertaining to care of veterans utilizing the facility. Contractor shall contact Contracting Officer and COR prior to disposing of any veterans records.

3. VA INFORMATION CUSTODIAL LANGUAGE

a. Information made available to the contractor or subcontractor by VA for the performance or administration of this contract or information developed by the contractor/subcontractor in performance or administration of the contract shall be used only for those purposes and shall not be used in any other way without the prior written agreement of the VA.