36C26119Q0367-001.docx

36C26119Q0367

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

662-19-3-9615-0004 36C26119Q0367 03-07-2019 Felicia A. DeMita 925-372-2038 03-15-2019 4:00PM Pacifc

612MCP

Department of Veterans Affairs VA Sierra Pacific Network (VISN 21) Network Contracting Office (NCO 21) 150 Muir Road, Bldg AB7 Martinez

CA

94553 623110 $27.5M X N/A X

612MCP

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

CA

95652-1012

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 also refer to the Addendum to Instructions to Offerors for additional guidance on responding to this Request for Quote.

Please send any questions to felicia.demita@va.gov.

This is a sole source acquisition to the current CNH provider. All responsible sources may submit a capability statement, proposal, or quotation, which shall be considered by the agency.

X X Felicia A. DeMita

VA-VHA-SAOW-2018-2D91603A

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: Contracting Officer 36C261

VA Sierra Pacific Network (VISN 21) Network Contracting Office (NCO 21) 150 Muir Road, Bldg AB7 Martinez CA 94553

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

3. INVOICES: Invoices shall be submitted in arrears:

4. GOVERNMENT INVOICE ADDRESS: All Invoices from the contractor shall be submitted electronically in accordance with VAAR Clause 852.232-72 Electronic Submission of Payment Requests.

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

PO Box 149971 Austin TX 78714-9971 ACKNOWLEDGMENT OF AMENDMENTS: The offeror acknowledges receipt of amendments to the Solicitation numbered and dated as follows:

36C26119Q0367

Page 1 of Page 1 of

SCHEDULE OF ITEMS

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: Rate adjustments may be requested by either the VA or the Contractor’s authorized Community Nursing Home (CNH) representative during the term of this IDC. Request for Rate adjustments must be accompanied by a justification for consideration by the Contracting Officer. If approved, the IDC must be modified and signed by both the Contractor and the VA Contracting Officer. The effective date of the rate adjustment will be the actual “Effective Date” as indicated on the IDC or the modification.

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.

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. 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).

7. 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.

8. Respite Care: The purpose of this level of care is to provide temporary relief to the primary care giver to help the veteran to continue reside in their primary residence for as-long-as possible. It is designed to accommodate referrals with minimum care needs. Patients with more complex care needs may not be appropriate for this level of care. Inpatient CNH respite reimbursement is provided at the VA’s discretion and must be pre-approved by a VA authorized official. Respite coverage is limited to 30 calendar days per every 12-months. No extensions will be granted at any time. No exceptions to this clause and the restrictions noted below will be granted.

a. No rehabilitation services, skilled services, 1:1 sitter or escort services, transportation services or ancillary services of any kind will be reimbursed during an episode of respite coverage.

b. The cost of medications during respite stays will not be reimbursed. Patient medication issuance or costs must be managed between the patient and the nursing home prior to the patient’s respite admission.

c. Inpatient respite discharge plans including discharge transportation must be pre-arranged between the patient/patient’s legal representative and the nursing home.

d. The VA will not be responsible for uninsured respite stays beyond the 30-calendar days.

9. CNH Hospice Coverage: Reimbursement for inpatient CNH hospice care requires pre-authorization. Approval will only be considered for established VISN patients who meet hospice clinical criteria, are enrolled in hospice services, and in conjunction with VA provider review and concurrence. This level of coverage is limited to a 6-month period after which additional VA Provider review and re-certification will be required for additional coverage approval. It is the responsibility of the CNH facility to request coverage extensions beyond the initial 6-months. It is also the responsibility of the CNH facility to notify the designated VA official of any patient hospice care disenrollment. A grace period of up to 30-days maximum will be provided for patients who no longer desire hospice care or meet hospice criteria to aid in their transition home or to apply for additional/alternative coverage. Rehabilitation therapy or other ancillary services for restorative purposes will not be approved while patient is under hospice coverage.

As the U.S. population ages and the spectrum of health problems faced by the elderly grows, the need to provide high quality, comprehensive, and cost-efficient care for the elderly increases.

10. 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.

11. Leave of Absence (LOA) – Bed-Holds: 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. 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 MedicAid, or if the Veteran choose 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.

12. Specialty Services are not included in the per-diem reimbursement rate. The CNH will assume responsibility for providing specialty/ancillary care for veterans (e.g., Dentistry, Ophthalmology, non-routine Podiatry, etc.) by arranging VA specialty clinic appointments or requesting pre-authorization for non-VA treatment for patients who are medically unable to travel to a VA clinic for this type of care.

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 at the same rate as a MediCare/MediCal covered patient.

b. All Dentistry/Orthodontia/Periodontal (Dental/Oral Care), Ophthalmology/Optometry (Vision Care), and Audiology (Hearing Care) must be received at the patient’s VA Medical Center. Appointments for this service can be made by contacting the patient’s primary VA Medical Center (the nearest VA Medical Center if the patient does not have a primary VA).

c. Pre-authorization is required for patients who are unable to receive the above (b) services at their local VA Medical Center due to their significantly acute medical or cognitive status. Documentation indicating their presenting status and their need for the additional service (b) must be made available for review and determination.

d. Patient Travel Escort Reimbursements are not considered part of routine nursing home care. It is the nursing home’s full responsibility to allocate the human resources to perform this service - The VA is not responsible for arranging or providing the staff to perform this duty. Pre-authorization for patient travel escort reimbursements are only provided for VA authorized medical appointments, when the patient has been observed and noted to be unable to safely travel without supervision/assistance. Pre-approval is required, and can only be received after the designated VA official receives documentation indicating the patient’s medical/cognitive limitations and confirming that the patient’s family/legal representative has been asked and is unable to provide this assistance.

e. 1:1 patient supervision is not considered part of routine nursing home care. This service must be pre-authorized. It is the nursing home’s full responsibility to allocate the human resources to perform this service - The VA is not responsible for arranging or providing the staff to perform this duty. Pre-authorization for 1:1 patient supervision reimbursement is only provided when the patient presents as an increased safety concern due to increased medical/cognitive/psychiatric acuity. The nursing home is responsible for submitting the request for 1:1 supervision in writing along with clinical justification/documentation indicating the patient’s presenting symptomology. The request must also note the frequency and length of time the service will be required (i.e. during waking hours/12-hours for 3-weeks) along with a plan of care to manage the presenting symptoms.

f. HIV care

PRICE SCHEDULE

Ordering Period One: April 1, 2019 – March 31, 2020

Rate per day is based upon ______% of the Contractor's current published Medicaid rate.

_______% of applicable RUG IV Group Code 2 Rate is based on the current published RUG IV group code classification rate as determined by MDS assessment in accordance with Centers for Medicare and Medicaid Service (CMS) Guidelines and Procedures, including ______% discount/supplement.

Rate per day is based on ______% of the Contractor's current published Medicaid rate.

Rate per day is based on _______% of the Contractor's current published Medicaid rate.

Rate per day is based on _______% of the Contractor's current published Medicaid rate

Ordering Period Two: April 1, 2020 – March 31, 2021

Rate per day is based upon ______% of the Contractor's current published Medicaid rate.

_______% of applicable RUG IV Group Code 2 Rate is based on the current published RUG IV group code classification rate as determined by MDS assessment in accordance with Centers for Medicare and Medicaid Service (CMS) Guidelines and Procedures, including ______% discount/supplement.

Rate per day is based on ______% of the Contractor's current published Medicaid rate.

Rate per day is based on _______% of the Contractor's current published Medicaid rate.

Rate per day is based on _______% of the Contractor's current published Medicaid rate

Ordering Period Three: April 1, 2021 – March 31, 2022

Rate per day is based upon ______% of the Contractor's current published Medicaid rate.

_______% of applicable RUG IV Group Code 2 Rate is based on the current published RUG IV group code classification rate as determined by MDS assessment in accordance with Centers for Medicare and Medicaid Service (CMS) Guidelines and Procedures, including ______% discount/supplement.

Rate per day is based on ______% of the Contractor's current published Medicaid rate.

Rate per day is based on _______% of the Contractor's current published Medicaid rate.

Rate per day is based on _______% of the Contractor's current published Medicaid rate

Performance Work Statement (PWS)

A. Overview

1. Federal Acquisition Regulation (FAR) – Indefinite Delivery - Indefinite Quantity. In accordance with FAR 16.703, Indefinite Delivery - Indefinite Quantity, this is an Indefinite Delivery - Indefinite Quantity (IDIQ) for the time from the “Award Date” for three annual ordering periods with an option to extend services to be exercised at the sole discretion of the Government. A binding contract is formed, in accordance with the terms and conditions of this IDIQ, when the Department of Veterans Affairs (VA) agrees to place a patient in the Community Nursing Home (CNH) and the CNH agrees to accept the patient. Upon acceptance by the Contractor of beneficiaries of VA, all terms and clauses of this IDIQ shall apply during such time as a VA patient remains in that CNH at the expense of VA.

2. Services Rendered at VA Per Diem Rates. Upon acceptance of a VA patient by the CNH, if and when requested by the VA Contracting Officer, 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%2Fvhapubli cations%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:

o 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.

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…