36C26120Q0081-006.docx

36C26120Q0081

A.1 VAAR 852.232-72 ELECTRONIC SUBMISSION OF PAYMENT REQUESTS (NOV 2018)

(a) Definitions. As used in this clause—

(1) Contract financing payment has the meaning given in FAR 32.001;

(2) Designated agency office means the office designated by the purchase order, agreement, or contract to first receive and review invoices. This office can be contractually designated as the receiving entity. This office may be different from the office issuing the payment;

(3) Electronic form means an automated system transmitting information electronically according to the accepted electronic data transmission methods and formats identified in paragraph (c) of this clause. Facsimile, email, and scanned documents are not acceptable electronic forms for submission of payment requests;

(4) Invoice payment has the meaning given in FAR 32.001; and

(5) Payment request means any request for contract financing payment or invoice payment submitted by the contractor under this contract.

(b) Electronic payment requests. Except as provided in paragraph (e) of this clause, the contractor shall submit payment requests in electronic form. Purchases paid with a Government-wide commercial purchase card are considered to be an electronic transaction for purposes of this rule, and therefore no additional electronic invoice submission is required.

(c) Data transmission. A contractor must ensure that the data transmission method and format are through one of the following:

(1) VA’s Electronic Invoice Presentment and Payment System at the current website address provided in the contract.

(2) Any system that conforms to the X12 electronic data interchange (EDI) formats established by the Accredited Standards Center (ASC) and chartered by the American National Standards Institute (ANSI).

(d) Invoice requirements. Invoices shall comply with FAR 32.905.

(e) Exceptions. If, based on one of the circumstances in this paragraph (e), the Contracting Officer directs that payment requests be made by mail, the Contractor shall submit payment requests by mail through the United States Postal Service to the designated agency office. Submission of payment requests by mail may be required for—

(1) Awards made to foreign vendors for work performed outside the United States;

(2) Classified contracts or purchases when electronic submission and processing of payment requests could compromise the safeguarding of classified or privacy information;

(3) Contracts awarded by contracting officers in the conduct of emergency operations, such as responses to national emergencies;

(4) Solicitations or contracts in which the designated agency office is a VA entity other than the VA Financial Services Center in Austin, Texas; or

(5) Solicitations or contracts in which the VA designated agency office does not have electronic invoicing capability as described above.

(End of Clause)

A.2 VAAR 852.237-70 INDEMNIFICATION AND MEDICAL LIABILITY INSURANCE (OCT 2019)

(a) It is expressly agreed and understood that this is a non-personal services contract, as defined in Federal Acquisition Regulation (FAR) 37.101, under which the professional services rendered by the Contractor or its health-care providers are rendered in its capacity as an independent contractor. The Government may evaluate the quality of professional and administrative services provided but retains no control over professional aspects of the services rendered including, by example, the Contractor’s or its health-care providers’ professional medical judgment, diagnosis, or specific medical treatments. The Contractor and its healthcare providers shall be liable for their liability-producing acts or omissions. The Contractor shall maintain or require all health-care providers performing under this contract to maintain, during the term of this contract, professional liability insurance issued by a responsible insurance carrier of not less than the following amount(s) per specialty per occurrence: *__________________. However, if the Contractor is an entity or a subdivision of a State that either provides for self-insurance or limits the liability or the amount of insurance purchased by State entities, then the insurance requirement of this contract shall be fulfilled by incorporating the provisions of the applicable State law.

* Amounts are listed below:

(b) An apparently successful offeror, upon request of the Contracting Officer, shall, prior to contract award, furnish evidence of the insurability of the offeror and/or of all healthcare providers who will perform under this contract. The submission shall provide evidence of insurability concerning the medical liability insurance required by paragraph (a) of this clause or the provisions of State law as to self-insurance, or limitations on liability or insurance.

(c) The Contractor shall, prior to commencement of services under the contract, provide to the Contracting Officer Certificates of Insurance or insurance policies evidencing the required insurance coverage and an endorsement stating that any cancellation or material change adversely affecting the Government’s interest shall not be effective until 30 days after the insurer or the Contractor gives written notice to the Contracting Officer. Certificates or policies shall be provided for the Contractor and/or each health-care provider who will perform under this contract.

(d) The Contractor shall notify the Contracting Officer within 5 days of becoming aware of a change in insurance providers during the performance period of this contract for all health-care providers performing under this contract. The notification shall provide evidence that the Contractor and/or health-care providers will meet all the requirements of this clause, including those concerning liability insurance and endorsements. These requirements may be met either under the new policy, or a combination of old and new policies, if applicable.

(e) The Contractor shall insert the substance of this clause, including this paragraph (e), in all subcontracts for healthcare services under this contract. The Contractor shall be responsible for compliance by any subcontractor or lowertier subcontractor with the provisions set forth in paragraph (a) of this clause. At least 5 days before the commencement of work by any subcontractor, the Contractor shall furnish to the Contracting Officer evidence of such insurance.

$1,000,000.00 per occurrence

(End of Clause)

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

36C26120Q0081 01-24-2020 Jason Huth 775-785-7158 01-27-2020

11:59 PM PST

612MCP

Department of Veterans Affairs Network Contracting Office (NCO) 21 975 Kirman Avenue Reno NV 89502-2597

X 623110 N/A X Department of Veteran Affairs VA San Francisco Health Care System 4150 Clement Street San Francisco CA 94121

612MCP

Department of Veterans Affairs Network Contracting Office (NCO) 21 975 Kirman Avenue Reno NV 89502-2597

Department of Veterans Affairs FMS VA-9(101) Financial Services Center PO Box 149971 Austin

TX

78714-9971 See CONTINUATION Page The Network Contracting Office (NCO) 21 requires Community nursing home (CNH) services for eligible veterans within San Francisco catchment area.

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

IDIQ Period of Performance: 02-01-2020 - 01-31-2025 Ordering Period One: 02-01-2020 - 01-31-2021 Ordering Period Two: 02-01-2021 - 01-31-2022 Ordering Period Three: 02-01-2021 - 01-31-2023 Ordering Period Four: 02-01-2023 - 01-31-2024 Ordering Period Five: 02-01-2024 - 01-31-2025 See CONTINUATION Page X Durell Salaz Contracting Officer 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:

b. GOVERNMENT: Contract Officer 36C261 Durell Salaz Department of Veterans Affairs Network Contracting Office (NCO) 21 5342 Dudley Blvd., Bldg. 209 McClellan CA 95652

c. ADMINISTRATIVE: Contract Specialist 36C261 Jason Huth Department of Veterans Affairs Network Contracting Office (NCO) 21 975 Kirman Avenue Reno NV 89502

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:

a) For patients authorized by the VA Palo Alto Health Care System, the Government Invoice Address is:

VA Palo Alto Health Care System 795 Willow Road, 640/136C Attn: Joellen Perkins Menlo Park, CA 94025

b) For patients authorized by the VA Central California Health Care System, the Government Invoice Address is:

Department of Veterans Affairs VA Central California Health Care System Attn: Bobette Varela Email: Bobette.Varela@va.gov 2615 E. Clinton Avenue Fresno, CA 93703

c) For patients authorized by the VA Northern California Health Care System, the Government Invoice Address is:

Department of Veterans Affairs Attn: Non-VA Care/Fee Service (612-04F) 201 Walnut Avenue Mare Island, CA 94592

d) For patients authorized by the VA Pacific Island Health Care System, the Government Invoice Address is:

Department of Veterans Affairs Attn: GREC Center for Aging 459 Patterson Road Honolulu, HI 96819

e) For patients authorized by the San Francisco VA Medical Center, the Government Invoice Address is:

CNH invoices are to be faxed to the SFVA CNH Invoice Fax line at 415-750-2284 San Francisco VA Medical Center Attn: GPEC – CNH (181G) 4150 Clement Street San Francisco, CA 94121

f) For patients authorized by the VA Sierra Nevada Health Care System, the Government Invoice Address is:

VA Sierra Nevada Health Care System Attn: Dixie Langus (Mail Code 018) 975 Kirman Avenue Reno, NV 89502

g) For patients authorized by the VA Southern Nevada Health Care System, the Government Invoice Address is:

VA Southern Nevada Health Care System Attn: Cheryl Martin 6900 N. Pecos Road Las Vegas, NV 89086

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

B.2 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 Indefinite Quantity (IDIQ) contract. 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 IDIQ. The per diem rate utilizes the Medicare/Medicaid Resident Assessment Instructions (RAI)/Minimum Data Set (MDS) assessment and RUGS score as the reference for rates. Assessment schedules identical to Medicare/Medicaid will be used; in addition, the VA reserves the right to request a resident re-assessment at any time during the coverage period.

1. 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 IDIQ. Request for Rate adjustments must be accompanied by a justification for consideration by the Contracting Officer. If approved, the IDIQ 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 IDIQ or the modification.

1. 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.

1. 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. If reimbursement rates are based off Medicare RUG rates, all medications are included in the per diem rate. If reimbursement rates are based off Medi-Cal rates then medications, which comprise more than 8.5% of the monthly per diem rate are excluded from the rate(s) established here. The cost of any high-priced drugs will be determined or priced using the Average Wholesale Price (AWP) of the drugs, plus a transaction fee of 3% per month. 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. 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.

1. 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:

4. Where the CNH only maintains private rooms; no double-occupancy rooms are available; and for ventilator-dependent patients with prior-negotiated rates.

0. 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.

1. 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).

1. 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.

1. 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.

1. 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 (Medicare/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.

1. 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.).and is responsible for issuing all reimbursement to sub-contracted providers with the VA SNF reimbursement funds.

9. 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 at patient’s VA Medical Center.

0. Basic and routine Podiatry care consists of:

0. Evaluation of the feet

0. Cutting or removal of corns and calluses

0. Trimming, cutting, and clipping of nails

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

9. 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.

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

0. Oral evaluations, routine cleanings, x-rays and fluoride treatments

1. Basic and routine Optometry (Vision Care) includes:

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

1. Basic and routine Audiology (Hearing Care)

2. Hearing and balance assessment

0. All other medically necessary and non-emergent treatment of diseases/disorders/injuries must be received at 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, pre-authorization is required. Documentation indicating their presenting status and their need for the additional service (a and b) must be made available for review and determination. These ancillary services include rehab at frequencies which do not trigger a RUG score.

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

2. Routine medication review

1. Includes routine pharmacy review and basic and routine psychotropic medication review

1. Specialty Services. CNH is required to arrange VA specialty clinic appointments, including psychiatric care or behavioral health therapy, 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.

1. 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, therefore it will be reimbursed by the VA at a reasonable and customary rate. It is the nursing home’s responsibility to allocate or provide through a third party the human resources to perform this service. The VA is not responsible for arranging or providing the staff to perform this duty. 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, and the facility has received an initial prior authorization from VA for a set duration of time. Once CNH provides documentation to VA confirming that the patient’s family/legal representative has been asked and is unable to provide this assistance, a paid escort may be arranged. Escorts do not require prior authorization for each individual appointment as long as the initial authorization has been granted and escort services are provided prior to the end date of the approval. Payment will be limited to the days that veteran had VA appointments, and will be reimbursed at usual and customary rates, not to exceed $32 per hour. An itemized bill must be submitted with claims in order to receive reimbursement.

11. Patients who are receiving inpatient psychiatric care in a Contracted Secured Inpatient Psychiatric/Behavioral Healthcare Facility (IMD/ICF-MI) Travel escorts are pre-approved upon the patient’s admission.

1. 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 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 only, 12/24 hours for 3 weeks) along with a plan of care to manage the presenting symptoms. An itemized bill must be submitted with claims in order to receive reimbursement.

1. 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 days per fiscal year. No extensions will be granted at any time. No exceptions to this clause and the restrictions noted below will be granted.

13. 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.

13. 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.

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

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

1. CNH Hospice Coverage: Reimbursement for inpatient CNH hospice care requires pre-authorization. Approval will only be considered for established VA patients who meet hospice clinical criteria, are enrolled in hospice services, and in conjunction with VA provider review and concurrence.

14. This level of coverage is limited to a 6-month period of time 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.

14. It is also the responsibility of the CNH facility to notify the designated VA official of any patient hospice care disenrollment.

1. 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.

1. Rehabilitation therapy or other ancillary services for restorative purposes will not be approved while patient is under hospice coverage.

1. HIV Care.

B.4 PERFORMANCE WORK STATEMENT

1. Overview

0. Federal Acquisition Regulation (FAR) – Indefinite Delivery Indefinite Quantity Contract (IDIQ). In accordance with FAR 16.504, Indefinite Delivery, Indefinite Quantity Contracts, this is an IDIQ from the “Award Date” for a period of five years.

0. 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 or authorized representative, the Contractor shall furnish all supplies and services herein described, at the per diem rates for the “Levels of Care” specified in the Schedule of Items of this IDIQ. The VA “Levels of Care” are defined in an attachment in Section D.1 of the solicitation and the IDIQ. VA is obligated only to the extent authorized placement of patients is made in accordance with this IDIQ. Any adjustments or modifications to this obligation require written preauthorization.

1. 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.

1. Requirements.

2. General. Nursing home facilities in the CNH program shall ensure that care meets the health needs and promotes the maximum well-being of VA patients. Nursing home care will be furnished to ensure the total medical, nursing, safety 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 room or private room only if clinically indicated, meals, nursing care, and other services or supplies commensurate with the VA-authorized level of care, without extra charge.

0. Nursing Home’s Responsibility for Patient Care: 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. This care includes times when VA beneficiaries are transported away from the nursing home to necessary medical appointments. Adequate supervision, care and treatment supplies (i.e. portable oxygen, dressing supplies, etc.) must be provided by the nursing home when a veteran is transported away from the nursing home to a medical appointment. This applies to clinical appointments at the VA Medical Center and Clinics (CBOCs) as well as medical appointments in the local community. See section 17, e if prior authorization is clinically required to cover the cost of staff or contracted providers to accompany/escort the veteran to his VA or VA-authorized appointment. For ventilator-dependent veterans who are receiving care in sub-acute faculties a RN must always accompany them when leaving the facility for appointments; the RN must be able to maintain the veteran’s airway and provide for a safe experience while away from the sub-acute facility.

0. 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.

1. 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.

1. VA Authorizations. Authorization for nursing home care will be submitted on VA Form 10-7078, “Authorization and Invoice for Medical and Hospital Services.” Each authorization validity period will be noted on the VA Form 10-7078 with a beginning and end date. Any extension to the original authorization validity period, regardless of the number of days, requires a new VA Form 10-7078 must be received prior to services being rendered.

1. Medicaid/Medicare Based Rates. The current State Medicaid/Medicare 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. VA will contract for appropriate Medicaid categories of care using Resource Utilization Groups (RUG-IV) as a guide. As with Medicare, a description of the RUG-IV systems can be found in 42 CFR Parts 409, et al.

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 as soon as the veteran arrives at the CNH. The CNH provider is responsible for general medical care, urgent evaluation and intervention. Provider visits will be according to the Center for Medicare and Medicaid Services (CMS) guidelines. The assigned nursing home provider will provide timely care following the most current CMS guidelines; arranging 24/7 access for patient care; arranging easy access to VA staff for consultation; providing timely response to calls and arranging for timely provider back-up according to OBRA guidelines (42 CFR 483.40, OBRA Guidelines).

0. 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 of 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. Additional provider visits will be reimbursed at the prevailing Medicare rate. Please refer to Appendix D for CNH Ancillary Services reimbursement protocols.

5. 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. Retroactive claims will not be approved – NO EXCEPTIONS. Please consult with any member of your VA CNH Team for authorization submission instructions

1. Description of Rehabilitative Therapy. The concept of rehabilitative therapy includes recovery or improvement in function and, when possible, restoration to a previous level of health and well-being. 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. Covered therapy services shall be rehabilitative therapy services unless they meet the criteria for maintenance therapy requiring the skills of a therapist.

1. Rehab authorizations for low RUG Scores: When 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. At the prevailing rate. Documentation should describe objective measurements which, when compared, show improvements in function, or decrease in severity, or rational for an optimistic outlook to justify continued treatment at the lower frequency.

1. 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.

1. Emergency Care; Financial Responsibility; Advanced Directives. In emergencies, nursing home staff will utilize the 911 local emergency systems as for any resident. Advance directives or living wills shall be adhered to according to CNH physician’s orders. When private hospitalization or emergency services are required, the patient, spouse, financial guardian or insurer may be 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.

1. 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.

1. State Licensure/Liability/Certifications; Access to CNH Quality of Care Reports. The CNH must maintain a current and unrestricted state license to operate as a skilled nursing facility/sub-acute facility or residential care facility. Changes in the status of the licensure will be immediately reported to the Contracting Officer Representative. The CNH must also maintain current Liability Insurance and current Center for Medicare and Medicaid Services (CMS) certifications. The 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.

1. Corrective Action Plan. 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:

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

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

9. 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;

9. 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

9. Provide dates when corrective action will be completed.

1. 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 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 will notify the VA Safety Manager responsible for the Life Safety Code inspection of the CNH and he/she will review (inspect the facility if required) the proposed changes and provide necessary approval or disapproval of the CNH to house veterans during and/or after the proposed changes. These changes may include but are not limited to:

10. Interior changes requiring VA approval. Some examples of facility changes that require the VA Contracting Officer 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;

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

10. 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

10. 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.

1. 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.

1. Re-admission to the VA Hospital and Emergency Care; Notification of Death of Veterans; CNH Responsibility to Veteran’s Belongings or Personal Effects. 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.

12. 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 notification must be performed within 72 hours of admission of the patient to a non-Federal facility and notice of any veteran death within 24 hours or immediately on the first business day after a weekend or holiday by faxing the approved form to the fiscally responsible VA Medical Center.

0. Upon discharge from hospitalization the CNH must submit a copy of the discharge summary to the CNH Clinical fax line (415) 750-6668.

12. 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.

12. 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.

12. 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.

1. Bed-Hold Statement: For re-hospitalizations or therapeutic passes, VA will pay a bed hold. The CNH is responsible for requesting all bed holds and, if applicable, bed hold renewals . VA will reimburse according to the prevailing State Medi-Cal rate or the pre-negotiated bed hold Rate. Bed old 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 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.

13. Hospitalizations: If the CNH facility is requesting bed hold reimbursement the request…