36C25924Q0569.docx

SUBJECT*

Montana VA Health Care System Fort Harrison, MT Community Nursing Home (CNH) Open and Continuous Requirement-Cascade, Fergus, Lake, Lewis and Clark, Madison, Silver Bow counties in Montana

GENERAL INFORMATION

SET-ASIDE

Network Contracting Office

NCO 19

6162 South Willow Drive, Suite 300 Greenwood Village CO 80111

POINT OF CONTACT*

Contract Specialist Catherine Kennedy catherine.kennedy@va.gov

PLACE OF PERFORMANCE

Fergus County, Montana

Lake County, Montana

Lewis and Clark County, Montana

Madison County, Montana Silver Bow County, Montana

POSTAL CODE

ADDITIONAL INFORMATION

AGENCY’S URL

URL DESCRIPTION

AGENCY CONTACT’S EMAIL ADDRESS

EMAIL DESCRIPTION

DESCRIPTION

Sources Sought Notice

SOURCES SOUGHT SYNOPSIS ONLY

1. The Department of Veterans Affair, Network Contracting Office 19, is seeking sources for a potential agreement to provide Community Nursing Home (CNH) Open and Continuous Requirement Services for Cascade County, Montana; Fergus County, Montana; Lake County, Montana; Lewis and Clark County, Montana; Madison County, Montana; and Silver Bow County, Montana at the Department of Veterans Affairs, Veterans Health administration, Montana VA Health Care System Fort Harrison.

2. The intended Firm-Fixed-Price Indefinite-Delivery Indefinite-Quantity (IDIQ) contract(s) period will be for five (5) years with no option periods.

3. The Government is interested in sources that can provide some or all of the required services as stated in the Scope of Work. Interested parties are encouraged to respond with what they can provide.

4. The purpose of this synopsis is to gain knowledge of potential qualified sources and their size classification (HUBZone, 8(a), small, small disadvantage, service-disabled veteran owned small business, or large business) relative to NACIS 623110 Nursing Care Facilities (Skilled Nursing Facilities). Responses to this synopsis will be used by the Government to make appropriate acquisition decisions. After review of the responses to this sources sought synopsis, a solicitation announcement may be published on Contract Opportunities or GSA. Responses to this sources sought synopsis are not considered adequate responses to the solicitation announcement.

5. This is a sources sought announcement ONLY and is NOT a request for proposals or quotes.

6. In response to this announcement, please provide the information below:

Company Name:

Address:

Unique Entity ID Number:

Contact Name:

Phone No.:

Email:

Business Size Information

Select all that applies:

· Small Business

· Emerging Small Business

· Small Disadvantaged Business

· Certified under Section 8(a) of the Small Business Act

· HubZone

· Woman Owned

· Certified Service-Disabled Veteran Owned Small

· Veteran Owned Small Business

· Large Business

FSS/GSA Contract Number

Effective Date/ Expiration Date

This notice is neither a request for competitive proposal or solicitation of offerors. This notice is to assist the VA in determining sources only and a solicitation is not currently available. If a solicitation is issued it will be announced at a later date, and all interested parties must respond to that solicitation announcement separately from this response. Responses to this sources sought is not a request to be added to a prospective bidders list or to receive a copy of the solicitation. Information received as a result of this notice will normally be considered solely for the purpose of determining whether to conduct a competitive procurement. This notice does not represent a commitment by the Government to pay for costs incurred in the preparation and submission of information or any other costs incurred as a response to this announcement. Inquiries will only be accepted in writing via email to Catherine.kennedy@va.gov on or before July 5, 2024 by 2:00PM MST.

See attached document: Performance Work Statement (PWS).

Sources Sought Notice Sources Sought Notice

Sources Sought Notice

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 VA 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 a review of the Medicare Care Compare ratings on which the CNH is evaluated based on local policy and directives established by the Medical Center and the Office of Geriatrics and Extended Care. Reference of 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). The per diem rate(s) established in this contract will include the cost of primary medical care, one (1) CNH provider visit every 30 days and/or per Medicare guidelines for mandated provider visits and as-needed for consultation, medications 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). 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 when appropriate. 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.

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. If a veteran no longer meets clinical eligibilities, the CNH will work with VA on an appropriate discharge plan.

5. VA Authorizations. Authorization for CNH care will be submitted in CPRS using the following template, “Community Care-GEC Community Nursing Home Consult” or another electronic format used by the VA. Each authorization validity period will be noted on the Community Care-GEC Community Nursing Home Consult with a beginning and end date. Any extension to the original authorization validity period, regardless of the number of days can be added as an addendum to the original authorization.

6. Patient Placement. The CNH Coordinator/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 will be identified in the post-award conference letter.

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. Therefore, the VA will coordinate care with an alternate CNH facility.

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 may be used as a basis for determination of VA rates. The VA rate will include medical care, nursing 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. The level of care classification and associated per diem rate will remain in effect for each placement until and unless one of the following events takes place:

a. The recipient is discharged and subsequently qualifies for a new admission assessment.

b. The nursing home submits an assessment requesting a change in the level of care classification and VA approves it. Classification changes may also occur based on a determination by VA.

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, and 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 upon request.

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. A Veteran authorized by the VA to be in a CNH facility may qualify for VA coverage of emergency care provided the VA Health Care System (VAHCS) if 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.

This contract will not require services that involve connection of one or more contractor-owned IT devices (such as a laptop computer or remote connection form a contractor system) to a VA internal trusted (i.e., non-public) network. The Certification & Accreditation (C & A) requirements do not apply, and a Security Accreditation Package is not required.

14. State Licensure; Access to CNH Quality of Care Reports (QASP Indicator #1). The CNH must maintain a current and unrestricted state license to operate as a skilled nursing facility. Changes in the status of the licensure will be immediately reported to the VA Home and Community Based 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 (QASP Indicator #2). The CNH will cooperate with timely development of Corrective Action Plans (CAPs) related to identified deficiencies and related to State, Federal or VA surveys. The CNH will develop in the time period specified by VA timely and appropriate CAPs for VA surveys or investigation of complaints related to quality of care or sentinel events. The CNH will also supply related documents or data as specified by VA. The CAPs will include but are not limited to the following criteria and shall:

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

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

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

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

e. Provide dates when corrective action will be completed.

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 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.

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

a. When such an admission is not feasible because of the nature of the emergency, hospitalization in a non-Federal facility may be accomplished provided VA authorization is obtained. VA authorization must be obtained within 72-hours of admission of the patient to a non-Federal facility and notice of any veteran death within 24-hours or immediately the first business day after a weekend or holiday. If hospitalization of a non-emergency nature is required, readmission to a VA Medical Center may be accomplished as soon as the patient’s condition is sufficiently stabilized to permit admission to a VA Medical Center. Absences of fifteen (15) consecutive calendar days or more, whether in a VA or in a non-Federal facility, require a new authorization.

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 and will reimburse according to the prevailing State Medicaid guidelines.

Bed-hold will begin the date the resident leaves the CNH if VA is notified of absence and bed-hold is requested at the time of notification. 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 (QASP Indicator #4). VA requires CNHs to report to the CNH Coordinator/COR/POC at VA for any of the following events within 24-hours or immediately the first business day after a weekend or holiday:

a. Sentinel events; 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.

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. 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 CMS Medicare Nursing Home Care Compare, the Government will take one or more of the following actions in accordance with the terms and conditions of the IDC 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 IDC from the subject CNH;

d. Not renew the IDC; and/or

e. Terminate the IDC.

22. VA Staff Access to CNH Records (QASP Indicator #5). The Contractor shall ensure that all medical records concerning the veteran’s care in the CNH will be readily accessible to VA, including remote access. 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 Community Care-GEC Community Nursing Home Consult

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/Specialized Prosthetics Equipment (e.g. Specialty bed). All Specialty Services must be pre-approved through the VA Consult process. The CNH will assume responsibility for arranging specialty care for veterans (e.g., dental care, podiatry, and ophthalmology). Veterans may be eligible for Specialized Prosthetic Equipment if clinically indicated. Pre-approval is required by the VA.

24. VA Health Care System Consultation/Resources. If emergency hospitalization is needed after evaluation by the CNH physician, contact VA at 406-447-6801 to speak to MOD (Medical Officer on Duty) to determine feasibility of transfer to VA Hospital. All other ER visits and/or hospitalizations are to be reported to Office of Community Care, Payment Operations and Management (POM) Office at 1-844-724-7842. 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 (QASP Indicator #6). Invoices for board, care and ancillary services shall be submitted promptly to the authorizing facility by the 15th calendar day following the end of the month in which services were rendered. The CNH will promptly notify the VA CNH Coordinator regarding any change in Veteran status: discharge, transfer, against medical advice (AMA), hospitalization, death and/or any changes in payer source and any ability to complete timely billing. All invoices must include the full name and address of the CNH and shall reflect the patient’s name, social security number, number of days billed, RUG category(ies), and agreed upon RUG rate (s). Failure to include this information may result in delayed payment. All invoices must be submitted using the UB04 form. Claims over one year will need to be submit through the claims process in accordance with the Federal Acquisition Regulation.

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. Ancillary costs may not be added to any invoice without written permission of the VA medical center. Ancillary services defined as supportive or diagnostic measures a physician may use to treat a patient. Anything that does not include room and board or direct care by a physician or nurse is considered ancillary. If permission is received, the nursing home must submit the physician’s order for the medication/supply, the dispensing log, the supplier, and the cost charged by the supplier to the nursing home. The CNH will be reimbursed based on local guidelines and VA pricing schedules.

b. High-cost 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. If Medication costs exceed 8.5% of the monthly per diem a medication exception should be requested through the Community Nursing Home Program. The MTVAHCS pharmacy will establish a course of action to compensate for the excess cost of medications. The course of action may include the provision of the high-cost medications through the VA pharmacy as defined as any medication that exceeds $2500/month, recommendation to provide an acceptable alternative medication or reimbursement for the amount of the high-cost medications in excess of 8.5%. The course of action will be documented in the Veterans medical records and entered in the CNH consult. All calculations will be made on a monthly basis. The VA 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. All pre-authorized requests for reimbursement for high-cost drugs and corresponding billing are due as soon as possible, but no later than 30 calendar days after use of products. Invoices for pharmacy reimbursement will be sent directly to:

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

c. 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 private room is strictly veteran, or family preferred; where the CNH only maintains private rooms; no double-occupancy rooms are available; and for ventilator-dependent patients with prior-negotiated rates.

d. 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. For information related to submitted claims please see:

· VA Community Care Contact Center at 1- 877-881-7618

· For claim status: Customer Engagement Portal (CEP) https://www.cep.fsc.va.gov

· FAX to 406-447-7645 Attention: CNH Coordinator

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. However, under this IDC, there is a guaranteed minimum. 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 IDC. 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 services), 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.

a. Contractors who are not able to use the HIPAA-compliant transactions are not required to do so. Supporting information for monthly invoices will be mailed or faxed to:

Department of Veteran Affairs HCBS/CNH Program, PO Box 1500, Mail Code 182H Fort Harrison, MT 59636-1500 or ATTN: CNH Program Coordinator

FAX: 406-447-7645

29. Information Technology Requirements.

END PERFORMANCE WORK STATEMENT

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Appendix b CONTRACT CLAUSE.docx

VA ACQUISITION REGULATION SOLICITATION PROVISION AND CONTRACT CLAUSE

NOTE: This clause will undergo official rule making by the Office of Acquisitions and Logistics. The below language will be submitted for public review through the Federal Register. The final wording of the clause may be changed from what is outlined below based on public review and comment. Once approved, the final language in the clause can be obtained from the Office of Acquisitions and Logistics Programs and Policy.

1. SUBPART 839.2 – INFORMATION AND INFORMATION TECHNOLOGY SECURITY REQUIREMENTS

839.201 Contract clause for Information and Information Technology Security:

a. Due to the threat of data breach, compromise or loss of information that resides on either VA-owned or contractor-owned systems, and to comply with Federal laws and regulations, VA has developed an Information and Information Technology Security clause to be used when VA sensitive information is accessed, used, stored, generated, transmitted, or exchanged by and between VA and a contractor, subcontractor or a third party in any format (e.g., paper, microfiche, electronic or magnetic portable media).

b. In solicitations and contracts where VA Sensitive Information or Information Technology will be accessed or utilized, the CO shall insert the clause found at 852.273-75, Security Requirements for Unclassified Information Technology Resources.

2. 852.273-75 - SECURITY REQUIREMENTS FOR UNCLASSIFIED INFORMATION TECHNOLOGY RESOURCES (INTERIM- OCTOBER 2008)

As prescribed in 839.201, insert the following clause:

The contractor, their personnel, and their subcontractors shall be subject to the Federal laws, regulations, standards, and VA Directives and Handbooks regarding information and information system security as delineated in this contract.

(END OF CLAUSE)

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Appendix C contract clause.docx

VA INFORMATION AND INFORMATION SYSTEM SECURITY/PRIVACY LANGUAGE FOR

INCLUSION INTO CONTRACTS, AS APPROPRIATE

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/subcontrator 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.

MARCH 12, 2010 VA HANDBOOK 6500.6

APPENDIX C

MARCH 12, 2010 VA HANDBOOK 6500.6

APPENDIX C

C-1

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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. This clause expressly limits the contractor/subcontractor's rights to use data as described in Rights in Data - General, FAR 52.227-14(d) (1).

b. VA information should not be co-mingled, if possible, with any other data on the contractors/subcontractor’s information systems or media storage systems in order to ensure VA requirements related to data protection and media sanitization can be met. If co-mingling must be allowed to meet the requirements of the business need, the contractor must ensure that VA’s information is returned to the VA or destroyed in accordance with VA’s sanitization requirements. VA reserves the right to conduct on site inspections of contractor and subcontractor IT resources to ensure data security controls, separation of data and job duties, and destruction/media sanitization procedures are in compliance with VA directive requirements.

c. Prior to termination or completion of this contract, contractor/subcontractor must not destroy information received from VA, or gathered/created by the contractor in the course of performing this contract without prior written approval by the VA. Any data destruction done on behalf of VA by a contractor/subcontractor must be done in accordance with National Archives and Records Administration (NARA) requirements as outlined in VA Directive 6300, Records and Information Management and its Handbook 6300.1 Records Management Procedures, applicable VA Records Control Schedules, and VA Handbook 6500.1, Electronic Media Sanitization. Self-certification by the contractor that the data destruction requirements above have been met must be sent to the VA Contracting Officer within 30 days of termination of the contract.

d. The contractor/subcontractor must receive, gather, store, back up, maintain, use, disclose and dispose of VA information only in compliance with the terms of the contract and applicable Federal and VA information confidentiality and security laws, regulations and policies. If Federal or VA information confidentiality and security laws, regulations and policies become applicable to the VA information or information systems after execution of the contract, or if NIST issues or updates applicable FIPS or Special Publications (SP) after execution of this contract, the parties agree to negotiate in good faith to implement the information confidentiality and security laws, regulations and policies in this contract.

e. The contractor/subcontractor shall not make copies of VA information except as authorized and necessary to perform the terms of the agreement or to preserve electronic information stored on contractor/subcontractor electronic storage media for restoration in case any electronic equipment or data used by the contractor/subcontractor needs to be restored to an operating state. If copies are made for restoration purposes, after the restoration is complete, the copies must be appropriately destroyed.

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f. If VA determines that the contractor has violated any of the information confidentiality, privacy, and security provisions of the contract, it shall be sufficient grounds for VA to withhold

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C-3 payment to the contractor or third party or terminate the contract for default or terminate for cause under Federal Acquisition Regulation (FAR) part 12.

g. If a VHA contract is terminated for cause, the associated BAA must also be terminated and appropriate actions taken in accordance with VHA Handbook 1600.01, Business Associate Agreements. Absent an agreement to use or disclose protected health information, there is no business associate relationship.

h. The contractor/subcontractor must store, transport, or transmit VA sensitive information in an encrypted form, using VA-approved encryption tools that are, at a minimum, FIPS 140-2 validated.

i. The contractor/subcontractor’s firewall and Web services security controls, if applicable, shall meet or exceed VA’s minimum requirements. VA Configuration Guidelines are available upon request.

j. Except for uses and disclosures of VA information authorized by this contract for performance of the contract, the contractor/subcontractor may use and disclose VA information only in two other situations: (i) in response to a qualifying order of a court of competent jurisdiction, or (ii) with VA’s prior written approval. The contractor/subcontractor must refer all requests for, demands for production of, or inquiries about, VA information and information systems to the VA contracting officer for response.

k. Notwithstanding the provision above, the contractor/subcontractor shall not release VA records protected by Title 38 U.S.C. 5705, confidentiality of medical quality assurance records and/or Title 38 U.S.C. 7332, confidentiality of certain health records pertaining to drug addiction, sickle cell anemia, alcoholism or alcohol abuse, or infection with human immunodeficiency virus. If the contractor/subcontractor is in receipt of a court order or other requests for the above mentioned information, that contractor/subcontractor shall immediately refer such court orders or other requests to the VA contracting officer for response.

l. For service that involves the storage, generating, transmitting, or exchanging of VA sensitive information but does not require C&A or an MOU-ISA for system interconnection, the contractor/subcontractor must complete a Contractor Security Control Assessment (CSCA) on a yearly basis and provide it to the COTR.

4. INFORMATION SYSTEM DESIGN AND DEVELOPMENT

a. Information systems that are designed or developed for or on behalf of VA at non-VA facilities shall comply with all VA directives developed in accordance with FISMA, HIPAA, NIST, and related VA security and privacy control requirements for Federal information systems. This includes standards for the protection of electronic PHI, outlined in 45 C.F.R. Part 164, Subpart C, information and system security categorization level designations in accordance with FIPS 199 and FIPS 200 with implementation of all baseline security controls commensurate with the FIPS 199 system security categorization (reference Appendix D of VA Handbook 6500, VA Information Security Program). During the development cycle a Privacy

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Impact Assessment (PIA) must be completed, provided to the COTR, and approved by the VA Privacy Service in accordance with Directive 6507, VA Privacy Impact Assessment.

b. The contractor/subcontractor shall certify to the COTR that applications are fully functional and operate correctly as intended on systems using the VA Federal Desktop Core Configuration (FDCC), and the common security configuration guidelines provided by NIST or the VA. This includes Internet Explorer 7 configured to operate on Windows XP and Vista (in Protected Mode on Vista) and future versions, as required.

c. The standard installation, operation, maintenance, updating, and patching of software shall not alter the configuration settings from the VA approved and FDCC configuration. Information technology staff must also use the Windows Installer Service for installation to the default “program files” directory and silently install and uninstall.

d. Applications designed for normal end users shall run in the standard user context without elevated system administration privileges.

e. The security controls must be designed, developed, approved by VA, and implemented in accordance with the provisions of VA security system development life cycle as outlined in NIST Special Publication 800-37, Guide for Applying the Risk Management Framework to Federal Information Systems, VA Handbook 6500, Information Security Program and VA Handbook 6500.5, Incorporating Security and Privacy in System Development Lifecycle.

f. The contractor/subcontractor is required to design, develop, or operate a System of Records Notice (SOR) on individuals to accomplish an agency function subject to the Privacy Act of 1974, (as amended), Public Law 93-579, December 31, 1974 (5 U.S.C. 552a) and applicable agency regulations. Violation of the Privacy Act may involve the imposition of criminal and civil penalties.

g. The contractor/subcontractor agrees to:

(1) Comply with the Privacy Act of 1974 (the Act) and the agency rules and regulations issued under the Act in the design, development, or operation of any system of records on individuals to accomplish an agency function when the contract specifically identifies:

(a) The Systems of Records (SOR); and

(b) The design, development, or operation work that the contractor/subcontractor is to perform;

(2) Include the Privacy Act notification contained in this contract in every solicitation and resulting subcontract and in every subcontract awarded without a solicitation, when the work statement in the proposed subcontract requires the redesign, development, or operation of a SOR on individuals that is subject to the Privacy Act; and

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(3) Include this Privacy Act clause, including this subparagraph (3), in all subcontracts awarded under this contract which requires the design, development, or operation of such a SOR.

h. In the event of violations of the Act, a civil action may be brought against the agency involved when the violation concerns the design, development, or operation of a SOR on individuals to accomplish an agency function, and criminal penalties may be imposed upon the officers or employees of the agency when the violation concerns the operation of a SOR on individuals to accomplish an agency function. For purposes of the Act, when the contract is for the operation of a SOR on individuals to accomplish an agency function, the contractor/subcontractor is considered to be an employee of the agency.

(1) “Operation of a System of Records” means performance of any of the activities associated with maintaining the SOR, including the collection, use, maintenance, and dissemination of records.

(2) “Record” means any item, collection, or grouping of information about an individual that is maintained by an agency, including, but not limited to, education, financial transactions, medical history, and criminal or employment history and contains the person’s name, or identifying number, symbol, or any other identifying particular assigned to the individual, such as a fingerprint or voiceprint, or a photograph.

(3) “System of Records” means a group of any records under the control of any agency from which information is retrieved by the name of the individual or by some identifying number, symbol, or other identifying particular assigned to the individual.

i. The vendor shall ensure the security of all procured or developed systems and technologies, including their subcomponents (hereinafter referred to as “Systems”), throughout the life of this contract and any extension,…