36C26119D0074-001.pdf

DEPARTMENT OF VETERANS AFFAIRS

Justification and Approval (J&A) For

Other Than Full and Open Competition (>$150K)

Acquisition Plan Action ID: 36C261-18-AP-2298 Purchase Request/2237 Number: 459-19-3-2641-0001

1. Contracting Activity:

Department of Veterans Affairs, VISN 21, Network Contract Office (NCO) 21 for the Veterans Affairs Pacific Islands Healthcare System (VAPIHCS)

2. Nature and/or Description of the Action Being Processed:

VAPIHCS is in need of Community Nursing Home (CNH) services in Honolulu, Hawaii to replace Basic Ordering Agreement (BOA), VA261-14-A-0024, with Avalon Care Center, D.B.A Hale Nani LLC that will expire on April 30, 2019. The 9 patients who are currently located at Hale Nani LLC that are impacted by this expiring BOA do not want to move as it will cause a medical hardship, disruption in treatment plans, and possibly negatively impact patient care.

In accordance with FAR 13.106-1(b)(1)(i), only one source available, an open market sole source award will be made to Avalon Care Center, DUNS: 077669539. The type of contract will be an Indefinite Delivery Indefinite Quantity (IDIQ) contract consisting of two ordering periods/years, due to the transition to Veteran Care Agreements pursuant to the VA Mission Act of 2018 sections 102 and 112. The estimated amount for the two ordering periods is .

FAR 13.5 Simplified Procedures for Certain Commercial Items: This procurement will be accomplished in accordance with FAR 13.5 Simplified Procedures for Certain Commercial Items and specifically FAR 13.501 Special Documentation Requirements, where acquisitions conducted under Simplified Acquisition Procedures are exempt from the requirements of FAR Part 6, but still require a justification using the format of FAR 6.303-2.

3. Description of Supplies/Services Required to Meet the Agency’s Needs:

The proposed action is to award an IDIQ Contract with a Nursing home facility capable of furnishing the total medical, nursing, and psychosocial needs of VA beneficiaries.

All nursing home facilities must have current Center for Medicare and Medicaid Services (CMS) certification (Medicare and/or Medicaid) and a State nursing home license.

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 must be provided at the rate of one (1) visit per month. Laboratory, x-ray, and other special services will be available to VA patients as needed. In addition, the care provided will include room, meals, nursing care, and other services or supplies commensurate with the VA-authorized level of care, without extra charge.

The per diem rate(s) established in this IDC will include the cost of primary medical care, one

(1) provider visit per month and needed consultation, drugs and routine supplies, laboratory, x-ray, and other special services authorized by VA, unless otherwise specifically excepted.

Full attention shall be given to motivating and educating patients to achieve and maintain independence in the activities of daily living. Every effort shall be made to keep patients ambulatory and to achieve an optimal level of self-care.

The government estimate for one year is . The period of performance will consist of two ordering periods and an option for a six-month extension via FAR 52.217-8. The Government estimate for the entire contract duration is The contract will have a ceiling of $3,000,000.00 to allow an increase over the government estimate since the nature of the service fluctuates based on need.

4. Statutory Authority Permitting Other than Full and Open Competition: FAR 13.5 Simplified Procedures for Certain Commercial Items; the authority for applying the Simplified Procedures for Commercial Items of FAR 13.5 is 41 U.S.C. 1901 and is implemented by for restricting competition on this procurement via FAR 13.106-1(b)(2).

5. Demonstration that the Contractor’s Unique Qualifications or Nature of the Acquisition

Requires the Use of the Authority Cited Above (applicability of authority):

As prescribed in VHA Handbook 1143.2, for more than 35 years the CNH Program has maintained two cornerstones: some level of patient choice in choosing a nursing home close to the veteran’s home and family, and a unique approach to local oversight of CNHs.

The quality of care for the veteran is accomplished through placement in a nursing home that is in close proximity to where the veteran and his/her family resides. Notably, in the VA’s community nursing home program, the veteran’s placement decision is made by VA, the veteran, and the veteran’s family. The placement decision will be based on established VA contracts in the area. The geographic factor in these circumstances makes this requirement unique and, therefore, not subject to competition.

According to the Medicare website’s “Nursing Home Compare” search, there are 15 CNH’s within the city limits of Honolulu, Hawaii, zip code 96822. However, these nursing homes are either smaller and cannot accommodate the existing patients or do not have space to accommodate this requirement.

Within a 10-mile radius of 96822, the zip code for Avalon Care Center, there are 20 CNH facilities.

According to the Contracting Officer Representative (COR), none of the other facilities, aside from Avalon Care Center, are interested in doing business with the VA or have the capacity for an additional nine patients. The demand for nursing home placement in Hawaii exceeds the supply.

Avalon Care Center currently has 9 veterans being treated at their facility. The nursing home meets VA exclusion review quality of care standards. The nursing home has had a Basic Ordering Agreement (BOA) in place with the VA since 2014 and has consistently provided excellent care to our Veterans. It would cause medical hardship on the 9 patients to move them, may disrupt treatment plans, and may be disruptive to family members if relocated to a different facility.

The current veterans require continued care at the nursing home facility beyond the current BOA task order expiration date of 30 April 2019, and for an unknown period of time in the future. To avoid disruption to the patients, the VA must enter into a new contract with the current contractor.

6. Description of Efforts Made to ensure that offers are solicited from as many potential sources as deemed practicable:

A query of Vet Biz using NAICS 623110, yielded twenty Service Disabled Veteran Owned Small Businesses (SDVOSB) and Veteran Owned Small Businesses (VOSB). However, upon further review of the services provided by the SDVOSB/VOSBs it appears as if none of the vendors actually have nursing home facilities in the State of Hawaii. Many of the vendors provide services in connection with nursing home facilities; however, none are actual nursing home facilities.

In accordance with FAR 13.501(a)(1)(iii), this action will be synopsized at award on the FBO and the justification will be made publicly available.

7. Determination by the Contracting Officer that the Anticipated Cost to the Government will be Fair and Reasonable:

Fair and reasonable pricing will be determined in accordance with FAR 13.106-3(a)(2). Pricing will be evaluated to be fair and reasonable based on a comparison to the Independent Government Cost Estimate (IGCE) and established Medicare Resource Utilization Group (RUG) rates and or Medicaid rates. The Government estimate was prepared based on established Medicare RUG rates for various levels of care and established VA nursing home rates based on VA national guidelines for determining cost for VA nursing home contracts.

8. Description of the Market Research Conducted and the Results, or a Statement of the Reasons Market Research Was Not Conducted:

The contract specialist conducted market research using Medicare’s website for nursing homes, reviewed available acquisition history and searched through the VA’s Veteran Information Pages.

Another form of market research conducted by the VA, is the on-going, periodic outreach with local potential vendors conducted by the COR.

9. Any Other Facts Supporting the Use of Other than Full and Open Competition:

VHA Handbook 1143.2 allows for a level of veteran choice in choosing a nursing home close to the veteran’s home and family. While there are other nursing homes within the vicinity of the Honolulu, HI area, the COR has stated that none of them are interested in doing business with the VA and/or do not have the capacity for an additional nine patients. Since there are Veterans currently residing in the incumbent’s facility, the VA does not intend on disrupting their care in order to place them at a different facility as it would not be in the Veteran’s best interest.

10. Listing of Sources that Expressed, in Writing, an Interest in the Acquisition:

The current contractor, Avalon Care Center, is willing to continue to provide services for the veterans in place.

11. A Statement of the Actions, if any, the Agency May Take to Remove or Overcome any Barriers to Competition before Making subsequent acquisitions for the supplies or services required:

Based on the inherent nature of the service and in line with VA policy where the veteran and his/her family plays a role in determining which nursing home facility will provide treatment for the veteran, the opportunity to increase competition is limited. Further, the recently enacted Mission Act is going to convert these services from requiring federal contracts to non-contract veteran care centers.

Consequently, within the next few years after full implementation of the Mission Act, there will no longer be a need to obtain competition in the context of the Federal Acquisition Regulation.

12. Requirements Certification:

I certify that the requirement outlined in this justification is a Bona Fide Need of the Department of Veterans Affairs and that the supporting data under my cognizance, which are included in the justification, are accurate and complete to the best of my knowledge and belief.

Dr. Rachel Murkofsky Date Associate Chief of Staff for Geriatrics, Rehabilitation and Extended Care VA Pacific Islands Healthcare System

13. Approvals in accordance with the VHAPM, Part 806.3: OFOC SOP.

a. Contracting Officer or Designee’s Certification (required): I certify that the foregoing justification is accurate and complete to the best of my knowledge and belief.

Nicole Do Date Contracting Officer Network Contract Office (NCO) 21

b. One Level Above the Contracting Officer (Required over$150K but not exceeding $700K):

I certify the justification meets requirements for other than full and open competition.

Brooke C. Robison, Director of Contracting Date

Network Contract Office (NCO) 21

Rachel L Murkofsky 241229

Digitally signed by Rachel L Murkofsky 241229 Date: 2019.03.15 13:50:09 -10'00'

Nicole N Do 503061

Digitally signed by Nicole N Do 503061 Date: 2019.03.15 15:34:19 -10'00'

BRIAN J. SANKO

205879

Digitally signed by BRIAN J.

SANKO 205879

Date: 2019.03.18 09:16:41 -07'00'

c. VHA SAO HCA Review and Approval: I have reviewed the foregoing justification and find it to be complete and accurate to the best of my knowledge and belief and recommend approval (if over $68 million) or approve ($700K to $68 million) for other than full and open competition.

Curtis M. Jordan Date Executive Director, Service Area Office West Head of Contracting Activity (HCA)

CURTIS M JORDAN

597130

Digitally signed by CURTIS M

JORDAN 597130

Date: 2019.03.21 21:17:58 -06'00'