36C26119Q0319-001.docx

36C26119Q0319

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

04-09-2019 Nicole Do 8085391301 04-12-2019

1:00 PM HST

612MCP

Department of Veterans Affairs VA Sierra Pacific Network (VISN 21) VA Northern California HealthCare System 5342 Dudley Blvd, Bldg 209 McClellan CA 95652-2609

623110

X

N/A

VA Northern California Healthcare System 5342 Dudley Blvd., Bldg. 209

McClellan CA 95652

612MCP

Department of Veterans Affairs Department of Veterans Affairs VA Northern California HealthCare System 3230 Peacekeeper Way, Bldg. 209 McClellan CA 95652-1012

Department of Veterans Affairs FMS VA-9(101) Financial Services Center

PO Box 149971 Austin TX 78714-9971

This is a Request for Quote for Nursing Home Services.

Please fill in the price schedule by inputting percentages.

Please refer to FAR 52.212-1 Addendum to Instructions to Offerors for additional guidance on responding to this Request for Quote.

Please send any questions to nicole.do@va.gov and andrea.kaplan@va.gov.

Procurement Authority Title 38 U.S.C. Code § 1720.

IDIQ Period of Performance:

Ordering Period One: 5/01/19 - 4/30/20 Ordering Period Two: 5/01/20 - 4/30/21

Nicole Do

VA-VHA-SAOW-2018-4BCE51EA

Table of Contents

SECTION B - CONTINUATION OF SF 1449 BLOCKS

B.1 CONTRACT ADMINISTRATION DATA

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

a. CONTRACTOR:

b. GOVERNMENT: 36C261 Contract Specialist: Andrea Kaplan Department of Veterans Affairs VA Sierra Pacific Network (VISN 21) VA Northern California HealthCare System 5342 Dudley Blvd, Bldg 209 McClellan CA 95652-2609

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: Vendors 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.

Vendors who are not able to use the HIPAA-compliant transactions are not required to do so. Supporting information for monthly invoices will be mailed to the VA Facility that authorized Care:

For patients authorized by the San Francisco VA Medical Center, the Government invoice address is:

United States Department of Veterans Affairs San Francisco Healthcare System 4150 Clement Street San Francisco, California 94121 ACKNOWLEDGMENT OF AMENDMENTS: The offeror acknowledges receipt of amendments to the Solicitation numbered and dated as follows:

Page 1 of Page 1 of

B.2 SCHEDULE OF ITEMS

RUG-IV Case Mix Classification

0001. Reduced Physical Function:

Residents whose needs are primarily for support with activities of daily living and general supervision.

Applicable RUG-IV Scores: PE2, PE1, PD2, PD1, PC2, PC1, PB2, PB1, PA2, PA1

0002. Behavioral Symptoms and Cognitive Performance:

Residents satisfying the following conditions:

0. Having a maximum ADL dependency score of 5 or less.

0. Having behavioral or cognitive performance symptoms, involving any of the following:

0. Difficulty in repeating words, temporal orientation, or recall (score on the Brief Interview for Mental Status, =9)

0. Difficulty in making self-understood, short term memory, or decision making (score on the Cognitive Performance Scale >=3),

0. Hallucinations,

0. Delusions,

0. Physical behavioral symptoms toward others

0. Verbal behavioral symptoms toward others,

0. Other behavioral symptoms,

0. Rejection of care, or

0. Wandering Applicable RUG-IV Scores: BB2, BB1, BA2, BA1

0003. Clinically Complex:

Residents receiving complex clinical care or have conditions requiring skilled nursing management, interventions, or treatments involving any of the following:

1. Pneumonia,

1. Hemiplegia with ADL dependency score of 5 or more,

1. Surgical Wounds or open lesions with treatment,

1. Burns,

1. Chemotherapy while a resident,

1. Oxygen Therapy while a resident,

1. IV Medications while a resident, or

1. Transfusions while a resident Applicable RUG-IV Scores: CE2, CE1, CD2, CD1, CC2, CC1, CB2, CB1, CA2, CA1

0004. Special Care Low:

Residents satisfying the following two conditions:

0. Having a minimum ADL dependency score of 2 or more.

0. Receiving complex clinical care or have serious medical conditions involving any of the following:

3. Cerebral Palsy with ADL dependency score of 5 or more,

3. Multiple Sclerosis with ADL dependency score of 5 or more,

3. Parkinson’s Disease with ADL dependency score of 5 or more,

3. Respiratory failure and oxygen therapy while a resident,

3. Tube feeding meeting intake requirement,

3. Ulcer treatment with two or more ulcers including venous ulcers, arterial ulcers, or Stage II pressure ulcers,

3. Ulcer treatment with any Stage III or IV pressure ulcer,

3. Foot infections or wounds with application of dressing,

3. Radiation therapy while a resident, or

3. Dialysis while a resident Applicable RUG-IV Scores: LE2, LE1, LD2, LD1, LC2, LC1, LB2, LB1

0005. Special Care High:

Residents satisfying the following two conditions:

0. Having a minimum ADL dependency score of 2 or more.

0. Receiving complex clinical care or have serious medical conditions involving any one of the following:

1. Comatose,

1. Septicemia,

1. Diabetes with insulin injections and insulin order changes,

1. Quadriplegia with higher minimum ADL dependence criterion (ADL score of 5 or more),

1. Chronic obstructive pulmonary disease (COPD) with shortness of breath when lying flat,

1. Fever with pneumonia, vomiting, weight loss, or tube feeding meeting intake requirement,

1. Parenteral/IV Feeding

1. Respiratory Therapy Applicable RUG-IV Scores: HE2, HE1, HD2, HD1, HC2, HC1, HB2, HB1

0006. Extensive Services:

Residents satisfying the following two conditions:

0. Having a minimum ADL dependency score of 2 or more.

0. While a resident, receiving complex clinical care and have needs involving: tracheostomy care, ventilator/respirator, and/or infection isolation.

Applicable RUG-IV Scores: ES3, ES2, ES1

0007. Rehabilitation:

Residents receiving physical therapy, occupational therapy, and/or speech-language pathology services while a resident.

Applicable RUG-IV Scores: RUA, RUB, RUC, RVA, RVB, RVC, RHA, RHB, RHC, RMA, RMB, RMC, RLA, RLB

0008. Rehabilitation Plus Extensive Services:

Residents satisfying all of the following three conditions:

0. Having a minimum activity of daily living (ADL) dependency score of 2 or more.

0. Receiving physical therapy, occupational therapy, and/or speech-language pathology services while a resident.

0. While a resident, receiving complex clinical care and have needs involving tracheostomy care, ventilator/respirator, and/or infection isolation.

Applicable RUG-IV Scores: RUX, RUL, RVX, RVL, RHX, RHL, RMX, RML, RLX, 0009. Bed Hold: For re-hospitalizations or therapeutic passes, VA may pay a bed hold upon CNH request with prior VA approval and best interest of VA or Veteran to do so. When deemed appropriate, VA will reimburse the CNH applicable per diem rate for bed hold not to exceed two (2) days per episode, four (4) days total per month (see Schedule of Items for applicable per diem rate). Also, see Bed Hold in the Performance Work Statement for additional details regarding Bed Hold circumstances.

0010. Ventilator Care: Veterans requiring the use of a ventilator will only be placed in a CNH-trained and equipped for those types of specialty patients. The CNH must be inspected and approved by the VA prior to any placements in the ventilator-designated room. Rates for ventilator care will be detailed in the pricing schedule and will be an all-inclusive per diem rate (including ventilator and supplies).

0012. One-on-One Observation Care: Defined as an assigned Certified Nursing Assistant dedicated to being at the Veteran’s side nonstop for duration of determined time, to assist with care needs of a Veteran diagnosed with Dementia with behavioral disturbances, Alzheimer’s with behavioral disturbances, Traumatic Brain Injuries, or Impulse Control Disorders. The key design is to reduce agitation or elopement risk and safety concerns for self or others and are NOT placed in a locked facility/unit. Other diagnoses may be considered but must have behavioral issues warranting such need of one-on-one care by VA CNH Program staff and is typically determine prior to placement. Advanced approval is required.

One-on-one care may also include escorts; accompanying the Veteran to VA referred appointment, for those Veterans that cannot clearly communicate their needs/concerns to the Provider performing the services and is approved for Special Mode Transportation arrangements to attend these appointments. No Veteran should be accompanied to any such appointment with more than one staff in total.

B.3 PRICE SCHEDULE

1. Rate Determination: The VA is seeking preferred rates, based on patient care need. VA rates are an all inclusive per diem rate. The per diem rate(s) will apply throughout the term of this Indefinite Delivery Contract (IDC). While the VA uses Medicare or State Medicaid rates as a reference, VA rates are independent of those payment systems and governed by the terms of this IDC. The per diem rate utilizes the Medicaid Resident Assessment Instructions (RAI)/Minimum Data Set (MDS) assessment and RUGS score as the reference for rates. Assessment schedules identical to Medicaid will be used; in addition, the VA reserves the right to request a resident re-assessment at any time during the coverage period.

2. Rate Adjustments: Rates will apply throughout the term of the IDC and are reflected as stated percentages above the Medicare/Medicaid rate(s), which are negotiated to cover the all-inclusive nature of the agreement and will not be negotiated. The rates will be computed and added to the published Medicaid rate for each level of care item. The contractor shall furnish proof of its Medicare/Medicaid rate as furnished by the State of Hawaii.

3. Rehabilitation Therapy: Any type of rehabilitation therapy (physical therapy, occupational therapy, speech therapy, etc.) requires the pre-approval of the VA before the initiation of therapy. Contractor shall provide Nursing home services in accordance with the attached performance work statement. Period of Performance is from date of award through two years and includes 2 ordering periods.

4. Medications: 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. The rate(s) shall be established at the Order Level. Medications, which comprise more than 8.5% of the monthly per diem rate are excluded from the rate(s) established here. 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 monthly. When a high cost drug patient is identified, VA staff must be advised promptly to establish an appropriate course of action, which may include the provision of the medication by the VA., 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. It is recommended that the accepting CNH request sufficient quantities of medication from the institution that the patient is being transferred from for the convenience and the ease of transition of the patient. Any externally provided medications will not be refilled unless specifically authorized by the patient’s primary care provider.

5. Private Rooms: Beneficiaries or their representatives may elect to pay separately for a private room. If a private room is requested, the VA beneficiary shall be obligated to pay the difference between the standard rate and the private room rate. This agreement should be in writing between the facility and the beneficiary or their legal representative, with a copy to the COR. No additional private room charge to the VA will be permitted. A private room rate for the management of 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 Ordering Official. No additional private room charge will be allowed in the following circumstances:

a. where the CNH only maintains private rooms; no double-occupancy rooms are available; and

b. for ventilator-dependent patients with prior-negotiated rates.

If the contractor elects to place a VA beneficiary in a private room without a formal request, then the VA is only obligated to pay the rate for the beneficiary’s current level of care under the terms of this contract.

6. Specialized Prosthetics Equipment (e.g., special bed and/or bariatric equipment: Veterans may be eligible for specialized equipment when clinically indicated. Pre-approval required by VA.

7. Transportation: Medically necessary transportation to and from the VA hospitals for clinics, evaluation or hospitalization will be arranged and paid by the VA hospital for Authorized CNH patients only and only when requested by the CNH facility with at least 48 business hours advanced notice. For transportation appointments, notify the VA Travel Designee/CNH Program Coordinator.

Contract Line Items:

VISN 21 anticipates awarding a single-award Indefinite Delivery Indefinite Quantity (IDIQ) contracts to responsible offeror(s) whose offer(s) conform(s) to the solicitation and will be most advantageous to the Government for a period two (2) years and the possibility of a 6-month extension.

Please provide your most favored customer/preferred rates. Rates are an all-inclusive per diem rate based on a percentage above your State Medicaid rate. Please indicate your proposed percentage (addition to State Medicaid rate) in the attached price schedule.

Note: Indefinite Delivery, Indefinite Quantity Contract is being used because it is impossible to determine with any certainty the exact amount of services that will be required under this contract.

The guaranteed minimum, for the contract is one room for one veteran for one day. The maximum of the contract, inclusive of ordering periods, shall not exceed $500,000. The Government does not guarantee that it will place any orders under this contract in excess of the guaranteed minimum award amount.

Ordering Period One: May 1, 2019 – April 30, 2020

VA BASE RATE[footnoteRef:2] [2: VA Base Rate is the basic per diem rate for Veterans receiving long term care in accordance with this PWS.]

= State Medicaid bed hold rate – no supplement

= State Medicaid Agency Rate + %

Supplemental %

Ordering Period Two: May 1, 2020 – April 30, 2021

VA BASE RATE[footnoteRef:8] [8: VA Base Rate is the basic per diem rate for Veterans receiving long term care in accordance with this PWS.]

= State Medicaid bed hold rate – no supplement

= State Medicaid Agency Rate + %

Supplemental %

B.4 PERFORMANCE WORK STATEMENT

Performance Work Statement (PWS) Community Nursing Home (CNH) Services Eureka, CA

A. Overview

1. Services Rendered at VA Per Diem Rates. Upon acceptance of a VA patient by the CNH, if and when requested by the VA Contracting Officer, VA Contracting Officer’s Representative or other authorized representative, the Contractor shall furnish all supplies and services herein described, at the per diem rates specified in the Schedule of Items of this IDIQ. The VA per diem rates are specified in the solicitation and the IDIQ. VA is obligated only to the extent authorized placement of patients is made in accordance with the IDIQ.

B. Background

1. 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 San Francisco Health Care System, in San Francisco, California at the prices specified in the section titled Schedule of Items of this IDIQ. Nursing home facilities in the CNH program shall cooperate with VA staff in referral of appropriate veterans for care and accept veterans of which they have the capability/capacity to care. The term, “facilities,” shall include but not be limited to rooms, wards, sections, eating areas, drinking fountains, entrances, and other like areas where patient medical/psycho-social care and well-being is provided for. 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.

C. Requirements

1. General. Nursing home facilities in the CNH program shall ensure that care meets the health needs and promotes the maximum well-being of VA patients. Nursing home care will be furnished to ensure the total medical, nursing, and psychosocial needs of VA beneficiaries. All nursing home facilities in VA’s CNH program must have current Center for MediCare and MedicAid Services (CMS) certification (MediCare and/or MedicAid) and a State nursing home license. VA has developed quality of care standards utilizing CMS inspection criteria that are followed by VA CNH Program Coordinators in their initial selection and approval of nursing facilities. See VHA Handbook 1143.2, “VHA Community Nursing Home Oversight Procedures (June 4, 2004) a copy of which is available at: https://www.index.va.gov/search/va/va_search.jsp?NQ=URL%3Ahttps%3A%2F%2Fwww.va.gov%2Fvhapublications%2Fpublications.cfm&QT=CNH+Handbook&submit.x=0&submit.y=0 VA often has a particular need for specialty care services in the CNH program. The VA requires CNHs to have bed capacity to ensure their ability to take referrals when requested. The CNH also must be able to accept VA referrals in a timely fashion (ideally within 24 hours of request). Provider visits will be available at the minimum 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 a semi-private room, meals, nursing care, and other services or supplies commensurate with the VA-authorized level of care, without extra charge. Duly authorized representatives of VA will provide quality oversight visits to veterans placed to assure continuity of care and to assist in the veterans’ transition back into the community. These visits do not substitute nor relieve the CNH in anyway of the responsibility for the daily care and medical/psycho-social treatment of the veteran.

a. Private Room: Beneficiaries or their representatives may elect to pay separately for a private room. If a private room is requested, the VA beneficiary shall be obligated to pay the difference between the standard rate and the private room rate. This agreement should be in writing between the facility and the beneficiary or their legal representative, with a copy to the COR. If the contractor elects to place a VA beneficiary in a private room without a formal request, then the VA is only obligated to pay the rate for the beneficiary’s current level of care under the terms of this contract.

2. 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 or the veteran.

3. VA Authorizations. Authorization for nursing home care will be provided by the VA on VA Form 10-7078, “Authorization and Invoice for Medical and Hospital Services.” Each authorization period will be noted on the VA Form 10-7078 with a beginning and end date. Any extension to the original authorization period, regardless of the number of days, requires a new VA Form 10-7078 and needs to be reviewed, and approved by the paying VA Community Nursing Home Program.

4. 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, routine medications, laboratory, x-ray, therapy (ies), and other special services authorized by VA, unless otherwise specifically exempted.

5. Primary Medical Coverage. The assigned CNH provider is the primary medical provider during the nursing home stay and is responsible for writing or approving admission and all other orders upon admission to 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 nursing home provider will provide timely care following the most current CMS guidelines; arranging 24/7 access for patient care; arranging easy access to 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).

a. Provider visits: As indicated in Section C, 1 above - Primary care physician visits are required to take place at a minimum of one (1) per month. These visits are included as part the per diem reimbursement rate, and in no case, are to be billed separately or billed to the patient or his/her family/representative. If a patient’s condition requires more frequent Primary Care Physician visits or requires specialty medical evaluation and treatment (i.e., wound care M.D. specialist) prior authorization from VA is required.

6. Rehabilitation Criteria. All therapy provided under this IDIQ will be individual therapy, rather than group therapy, unless otherwise ordered by the authorizing VA facility. Therapy 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. Covered therapy services shall be rehabilitative therapy services. The concept of rehabilitative therapy includes recovery or improvement in function and, when possible, restoration to a previous level of health and well-being. Therefore, evaluation, re-evaluation and assessment documented in the Progress Report should describe objective measurements which, when compared, show improvements in function, or decrease in severity, or justification for an optimistic outlook to justify continued treatment.

i. When a rehabilitative therapy frequencies do not trigger a high enough RUG score to issue the appropriate reimbursement for rehabilitative therapy, these services can be approved as an ancillary service. Documentation indicating the patient’s presenting status and their need for the rehabilitative therapy at the lower frequency must be made available for review and determination.

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.

7. Emergency Care; Financial Responsibility; Advanced Directives. In emergencies, nursing home staff will utilize the 911 local emergency systems as it would 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 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.

8. HIPAA Compliance. HIPAA compliance is required. The Contractor must adhere to the provisions of Public Law 104-191, Health Insurance Portability and Accountability Act (HIPAA) of 1996 and the National Standards to Protect the Privacy and Security of Protected Health Information (PHI). As required by HIPAA, the Department of Health and Human Services (HHS) has promulgated rules governing the security and use and disclosure of protected health information by covered entities, including the Department of Veterans Affairs (VA). In accordance with HIPAA, the Contractor may be required to enter into a Business Associate Agreement (BAA) with VA, but VACO has recognized CNH Facilities as an entity that does not require a BAA as long as they are conducting health care on VA’s behalf. The CNH care program qualifies as a medical service, so no BAA is required.

9. 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 Contracting Officer Representative. VA will monitor the professional care and administrative management of services provided to VA beneficiaries under this IDIQ, 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 IDIQ, including VA’s on-site inspection and monitoring. The VA Contracting Officer and Contracting Officer’s Representative shall make all final determinations as to the Contractor’s reasonable cooperation with VA and compliance with these requirements.

10. 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.

11. Life Safety Code. The CNH’s building shall conform to the most recent standards of the Life Safety Code (National Fire Protection Association Standard #101) in effect on the date of the IDIQ award and compliance with all applicable Federal, State and local regulations. The administrator of the CNH is required to notify the VA Contracting Officer’s Representative in writing at least thirty (30) calendar days prior to any planned facility changes that could impact the Life Safety Code and other safety features of the facility which were in existence at the time this IDIQ became effective. The VA Contracting Officer’s Representative 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. This information will be reported to the Contracting Officer. These changes may include but are not limited to:

a. Interior changes requiring VA approval. Some examples of facility changes that require VA Contracting Officer’s Representative 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% sprinkled;

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

12. Acceptable Safety and Sanitation Practices. Acceptable safety and sanitation practices shall be observed throughout the facility. The CNH will address employee and patient safety practices through staff orientation, training and adherence to related policy or procedures to provide a safe and clean environment.

13. 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.

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

c. When disposition has been made, the itemized inventory with annotation as to the disposition of the funds and effects will be immediately forwarded to the VA facility 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.

14. 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 Program Coordinator based on individual patient needs but are generally limited to two (2) times per month and should be pre-approved. The CNH is responsible for requesting all bed holds and if applicable bed hold renewals. If the CNH facility is requesting bed hold reimbursement the request must be submitted immediately, but no later than 14-days after the patient’s hospitalization. Requests submitted after 14-days may not be approved. VA may cover bed holds based on the following plan:

The host VA medical center will select one of the following options:

a. 5 days maximum/episode, pre-approved by VA when in the best interest of the Veteran and VA. Exceptions to this are approved at VAMC level;

b. When deemed appropriate, VA will reimburse the CNH the applicable rate for bed hold not to exceed two (2) days per episode, four (4) days total per month for therapeutic home visit pass.

c. VA will reimburse according to the prevailing State Medi-Cal 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. If the Veteran chooses to return to the CNH from a hospitalization under another form of coverage/insurance (Medicare/Medicaid), or if the Veteran chooses not to return, or is not permitted to return to the facility the total VA bed hold reimbursement will be revoked. Absences of fifteen (15) consecutive calendar days or more, whether in a VA Hospital or in a non-VA Hospital require a new authorization agreement. The nursing home 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.

i. Bed hold extensions beyond 15-days are considered on a case by case basis. Review by the SFVA GPEC Associate Chief or SFVA GPEC Medical Director is required. The patient must present with significant clinical acuity along with limited placement options to be considered for review.

15. Reportable Events (QASP Indicator #4). VA requires CNH’s to report to the CNH Program Coordinator any of the following events within 24 hours or immediately the first business day after a weekend or holiday: 1) sentinel events; 2) when there is a change of ownership of the CNH; 3) when there is a change of nursing home administrator or Director of Nursing/Director of Nursing Service; 4) substantiated allegations of mistreatment, neglect, abuse or misappropriation of CNH veterans or property; 5) elopements of CNH veterans pursuant to state regulations; 6) infectious outbreaks; 7) resident to resident or resident to staff altercations involving a CNH veteran resulting in any injury that is other than minor; 8) copies of annual surveys or substantiated complaint investigations conducted by a State oversight agency; and 9) adverse events. Reporting shall include date of occurrence and patient disposition and outcome.

a. A sentinel event may include, but is not limited to the following: 1) a fall resulting in death or injury; 2) elopement resulting in a missing patient; 3) patient abuse confirmed or under suspicion; 4) a medication error resulting in patient illness or injury; 5) death or patient injury related to restraint (including side rails) use; or 6) death related to an unconfirmed or suspicious cause. When an adverse event occurs involving a CNH Veteran which is not determined to be a Sentinel Event (but that the State requires that the occurrence be reported to the State), such event is also to be reported to VA’s CNH Program Coordinator. 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 nursing homes to report such incidents to the CNH Program Coordinator.

16. VA Actions Regarding Serious Quality of Care Deficiencies. In cases of serious deficiencies affecting the health or safety of veterans or in cases of continued uncorrected deficiencies, VA will take one or more of the following actions in accordance with the terms and clauses of the IDIQ and applicable procurement regulations:

a. Increase VA staffing monitoring until the State survey agency clears the deficiency;

b. Suspend placement of veterans in the CNH;

c. Remove or transfer veterans under the IDIQ from the subject CNH;

d. Not renew the IDIQ; and/or

e. Immediately terminate the IDIQ.

17. VA Staff Access to CNH Records (QASP Indicator #5). All medical records concerning the veteran’s care in the CNH will be made available to VA nurses, social workers and other authorized members of the VA CNH Program, including remote access to the electronic records. 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). A medical record shall be maintained for each patient, which includes at least the following:

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

3. Interdisciplinary progress notes to include effect of care provided, veterans’ response to treatment, change in condition, and changes in treatment;

4. Medical practitioner orders which are signed and dated;

5. Allergies;

6. Person to contact in an emergency situation;

7. Name of attending medical practitioner; and

8. Advanced directives if available.

18. 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.

19. Routine Ancillary Services are included in the per diem reimbursement rate. The CNH will assume responsibility for providing ancillary care for veterans (e.g., Dentistry, Optometry, Podiatry, etc.).

a. All Podiatry that is reasonably considered to be *basic or routine is included in the per diem reimbursement rate. At no time is the patient or the patient’s family/representative to be billed for this service. The patient is expected to receive routine podiatry care every other month. All other medically necessary and non-emergent treatment of foot diseases/disorders/injuries must be received through the patient’s VA Medical Center.

· Basic and routine Podiatry care consists of:

· Evaluation of the feet

· Cutting or removal of corns and calluses

· Trimming, cutting, and clipping of nails

· Hygienic or other preventive maintenance, including cleaning and soaking the feet

b. Dentistry (basic Oral Care) and, Optometry (Vision Care), and Audiology (Hearing Care) that is reasonably considered to be *basic or routine is included in the per diem reimbursement rate. At no time is the patient or the patient’s family/representative to be billed for these services. The patient is expected to receive routine care at the same frequency as a Medicare/MediCal covered patient.

· Basic and routine Dentistry (Dental/Oral Care) includes:

· Oral evaluations, routine cleanings, x-rays and fluoride treatments

· Basic and routine Optometry (Vision Care) includes:

· Screening for eye disease, and/or updating eyeglass or contact lens prescriptions

· Basic and routine Audiology (Hearing Care)

· Hearing and balance assessment

i. All other medically necessary and non-emergent treatment of diseases/disorders/injuries must be received through the patient’s VA Medical Center. For patients who are unable to receive these services at their local VA Medical Center due to their significantly acute medical or cognitive status, or if frequency of treatment/care required is not reasonably feasible for the patient or CNH facility (i.e. daily or multiple times per week), pre-authorization is required. These ancillary services include rehab at utilization frequencies which do not trigger a RUG score. Documentation indicating their presenting status and their need for the additional service (a and b) must be made available for review and determination.

ii. Patient may also choose to receive the above (a and b) routine and basic services at his VA Medical Center. The CNH will assist the patient with arranging necessary appointments.

iii. Per diem rate or price per treatment for all ancillary services must be provided prior to approval and must not exceed proposed Medicare or Medi-cal pricing.

c. Specialty Services. CNH is required to arrange VA specialty clinic appointments when consults or treatment are needed, or in cases where patients who are medically unable to travel to a VA medical center or clinic, CNH will request pre-authorization for non-VA treatment in the local community.

d. Travel escorts to VA appointments for patients needing assistance (due to physical, cognitive or behavioral issues) are not considered part of routine nursing home care,…