36C26120Q0360-003.pdf

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 68

36C26120Q0360 03-30-2020

Latasha Winston 916-923-4973 04-03-2020

11:59 PM PST

612MCP

Department of Veterans Affairs

VA Sierra Pacific Network (VISN 21)

VA Northern California HealthCare System

5342 Dudley Blvd, Bldg 209

McClellan CA 95652-2609

X

623110

N/A

X

Department of Veteran Affairs

VA Palo Alto Health Care System

3801 Miranda Avenue

Palo Alto, CA 94304

612MCP

Department of Veterans Affairs

Network Contracting Office (NCO) 21

5354 Dudley Blvd., Bldg. 209

McClellan, CA 95652-2609

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

Palo Alto catchment area.

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

IDIQ Period of Performance: 04/10/2020 - 04/09/2025

Ordering Period One: 04/10/2020 -04/09/2021

Ordering Period Two: 04/10/2021 - 04/09/2022

Ordering Period Three: 04/10/2022 - 04/09/2023

Ordering Period Four: 04/10/2023 - 04/09/2024

Ordering Period Five: 04/10/2024 - 04/09/2025

See CONTINUATION Page

X X

Latasha Winston

Contracting Officer

36C26120Q0360

Table of Contents

SECTION B - CONTINUATION OF SF 1449 BLOCKS

B.1 CONTRACT ADMINISTRATION DATA

B.2 SCHEDULE OF ITEMS

B.3 SCHEDULE OF SERVICES

B.4 PERFORMANCE WORK STATEMENT

SECTION C - CONTRACT CLAUSES

C.1 52.212-4 CONTRACT TERMS AND CONDITIONS—COMMERCIAL ITEMS (OCT

2018)

C.2 52.216-18 ORDERING (OCT 1995)

C.3 52.216-19 ORDER LIMITATIONS (OCT 1995)

C.4 52.216-22 INDEFINITE QUANTITY (OCT 1995)

C.5 52.217-8 OPTION TO EXTEND SERVICES (NOV 1999)

C.6 52.232-19 AVAILABILITY OF FUNDS FOR THE NEXT FISCAL YEAR (APR 1984) 29

C.7 VAAR 852.203-70 COMMERCIAL ADVERTISING (MAY 2018)

C.8 VAAR 852.216-73 ECONOMIC PRICE ADJUSTMENT—STATE NURSING HOME

CARE FOR VETERANS (MAR 2018)

C.9 VAAR 852.222-70 CONTRACT WORK HOURS AND SAFETY STANDARDS ACT—

NURSING HOME CARE FOR VETERANS (MAY 2018)

C.10 VAAR 852.232-72 ELECTRONIC SUBMISSION OF PAYMENT REQUESTS (NOV

2018)

C.11 VAAR 852.237-70 INDEMNIFICATION AND MEDICAL LIABILITY INSURANCE

(OCT 2019)

C.12 VAAR 852.270-1 REPRESENTATIVES OF CONTRACTING OFFICERS (JAN 2008) 33

C.13 MANDATORY WRITTEN DISCLOSURES

C.14 52.252-2 CLAUSES INCORPORATED BY REFERENCE (FEB 1998)

C.15 52.212-5 CONTRACT TERMS AND CONDITIONS REQUIRED TO IMPLEMENT

STATUTES OR EXECUTIVE ORDERS—COMMERCIAL ITEMS (JAN 2020)

SECTION D - CONTRACT DOCUMENTS, EXHIBITS, OR ATTACHMENTS

ATTACHMENT 1 RUGs IV DESCRIPTIONS

ATTACHMENT 2 QUALITY ASSURANCE SURVEILLANCE PLAN

ATTACHMENT 3 WAGE DETERMINATION 1973-0130 (REV.-58) CNH

SECTION E - SOLICITATION PROVISIONS

E.1 52.212-1 INSTRUCTIONS TO OFFERORS—COMMERCIAL ITEMS (OCT 2018)

E.2 52.204-24 REPRESENTATION REGARDING CERTAIN TELECOMMUNICATIONS

AND VIDEO SURVEILLANCE SERVICES OR EQUIPMENT (DEC 2019)

E.3 52.209-7 INFORMATION REGARDING RESPONSIBILITY MATTERS (OCT 2018)

E.4 52.216-1 TYPE OF CONTRACT (APR 1984)

E.5 52.217-5 EVALUATION OF OPTIONS (JUL 1990)

E.6 52.233-2 SERVICE OF PROTEST (SEP 2006)

E.7 VAAR 852.233-70 PROTEST CONTENT/ALTERNATIVE DISPUTE RESOLUTION

(OCT 2018)

E.8 VAAR 852.273-73 EVALUATION - HEALTH-CARE RESOURCES (JAN 2003)

E.9 VAAR 852.273-74 AWARD WITHOUT EXCHANGES (JAN 2003)

E.10 52.252-1 SOLICITATION PROVISIONS INCORPORATED BY REFERENCE (FEB

1998)

E.11 52.212-3 OFFEROR REPRESENTATIONS AND CERTIFICATIONS—COMMERCIAL

ITEMS (DEC 2019)

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: TBD

b. GOVERNMENT: Contract Specialist 36C261 Latasha Winston

Network Contracting Office (NCO) 21

5342 Dudley Blvd., Bldg. 209

McClellan CA 95652

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

[X] 52.232-33, Payment by Electronic Funds Transfer—System For Award Management, or

[ ] 52.232-36, Payment by Third Party

3. INVOICES: Invoices shall be submitted in arrears:

a. Quarterly [ ]

b. Semi-Annually [ ]

c. Other [X] Monthly - 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

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

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

VA Southern Nevada Health Care System

Attn: Cheryl Martin

6900 N. Pecos Road

Las Vegas, NV 89086 mailto:Bobette.Varela@va.gov

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

AMENDMENT NO DATE

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 based on a percentage of Medicare or State Medicaid. The per diem rate(s) will apply throughout the term of this Indefinite Delivery, Indefinite Quantity

Contract (IDIQ). 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 Medicaid Resident Assessment Instructions (RAI)/Minimum Data Set (MDS) assessment and RUGS score as the reference for rates. Assessment schedules identical to

Medicaid will be used; in addition, the VA reserves the right to request a resident re-assessment at any time during the coverage period.

2. Rate Adjustments: Rates will apply throughout the term of the IDIQ and are reflected as stated percentages above the Medicaid rate(s), which are negotiated to cover the all-inclusive nature of the agreement and will not be negotiated. The rates will be computed and added to the published

Medicaid rate for each level of care item. California rates are located at http://www.dhcs.ca.gov/services/medi-cal/Pages/AB1629/LTCAB1629.aspx and Nevada rates are located at http://dhcfp.nv.gov/Resources/Rates/NursingFacilities/ .

For non-Medicaid nursing homes, the rates will be established/negotiated prior to award of the

IDIQ and remain applicable throughout the term of the IDIQ.

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: All Medications administered to VA-contracted Veterans residing in a CNH will be charged at the Average Wholesale Price (AWP) or according to the pharmacy bill, whichever is less. Medication costs up to 8.5% of billed care are included in the RUG rate pricing.

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 on a monthly basis.

When a patient’s medication costs are determined to be in excess of the 8.5%, the VA must be promptly alerted to establish an appropriate course of action. This course of action may include the VA providing medication(s) to the CNH for the contracted Veteran 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. The VA also 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.

5. Private Rooms: A private room rate for clinical concerns such as communicable diseases or infections (e.g., MRSA, VRE), or other pertinent clinical needs may be charged above the negotiated RUG rate for that facility with prior approval by the VA CNH Coordinator or designated VA staff. However, no additional private room charge will be allowed in the following circumstances: where the CNH only maintains private rooms; no double-occupancy rooms are available; and for ventilator-dependent patients with prior-negotiated rates.

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

VA.

http://www.dhcs.ca.gov/services/medi-cal/Pages/AB1629/LTCAB1629.aspx http://dhcfp.nv.gov/Resources/Rates/NursingFacilities/

7. Specialty Services: Payment for specialty services, such as but not limited to podiatry, dentistry, optometry or audiology, are not included in the per diem reimbursement rate. The CNH will assume responsibility for arranging specialty care for veterans by scheduling VA specialty appointments or requesting pre-authorization for either non-VA-Care or CNH in-house providers when such a decision is in the best interest of the veteran and the VA.

8. Ventilator Care (if applicable): 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).

9. Escort Services (if applicable): Payment for escort services is not included in the per diem reimbursement rate. VA is not responsible for arranging or providing the staff for this duty.

Veteran, responsible party, payee or conservator may be contacted for payment

B.3 SCHEDULE OF SERVICES

Contractor shall provide Nursing Home Care services for eligible Veterans at contractor’s place of business within the Santa Cruz, CA area. All services shall be provided in accordance with the specifications, terms and conditions contained herein.

The guaranteed minimum, for the contract is one room for one veteran for one day. The maximum of the contract, inclusive of ordering periods, shall not exceed $5,000,000.00. The Government does not guarantee that it will place any orders under this contract in excess of the guaranteed minimum award amount.

(NOTE: The reference to the published rate means the date the rates are published and distributed, not the effective dates. In other words, if the rates are effective August 1, but they are not published until the subsequent March, then the rates for this contract would change in March.)

PERIOD OF PERFORMANCE: April 10, 2020 through April 09, 2025

ITEM

NUMBER

DESCRIPTION OF SUPPLIES/SERVICES UNIT PER DIEM RATE

BED HOLD

(State Medicaid Daily Rate = VA BASE)

DY Reimbursed at Current State

Medicaid without

Supplement

RESPITE

(State Medicaid Daily Rate = VA BASE)

DY Reimbursed at Current State

Medicaid without

Supplement

HOSPICE CARE

DY Reimbursed at Current State

Medicaid daily rate plus

REDUCED PHYSICAL FUNCTION,

BEHAVIOR & COGNITIVE

PERFORMANCE

DY Reimbursed at Current State

Medicaid daily rate plus

CLINICALLY COMPLEX

Medicaid daily rate Plus

SPECIAL CARE HIGH

SPECIAL CARE LOW

EXTENSIVE SERVICES

REHABILITATION

Medicaid Plus ___%

REHABILITATION + EXTENSIVE

SERVICES

Ordering officers (OOs) may be authorized to place orders against this contract. The Contracting Officer

(CO) will furnish the Contractor with the names of individuals authorized as OOs, by separate memorandum upon issuance of the contract. When OOs are added after award, the CO will furnish the

Contractor with the names of individuals authorized as OOs, by memorandum upon OO appointment.

OOs are responsible for issuing and administering orders placed under this contract. OOs have no authority to modify any term of this basic contract. Any deviation from the terms of the basic contract must be approved in writing by the CO responsible for this contract. The Contractor shall accept orders against this contract only from the CO and/or authorized OOs. Fulfilling orders from persons other than the CO or OO may result in loss or delay in payment for supplies/services provided under such orders.

B.4 PERFORMANCE WORK STATEMENT

1. 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 five-year ordering periods.

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 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.

3. Background/Introduction. The Community Nursing Home (CNH) program is a key component of the Veterans Health Administration (VHA) continuum of care. The Contractor agrees to provide in accordance with the terms and conditions stated herein to the U.S. Department of Veterans Affairs

Palo Alto Health Care System (VAPAHCS), in Palo Alto, CA 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. 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.

4. Requirements. Nursing home facilities in the CNH program shall ensure that care meets the health needs and promotes the maximum well-being of VA beneficiaries. Nursing home care will be furnished based on an interdisciplinary assessment to ensure the total medical, nursing, and psychosocial needs of VA beneficiaries are being met. Full attention shall be given to motivating and educating patients to achieve and maintain independence in the activities of daily living, to the maximum extent possible. Every effort shall be made to keep Veterans ambulatory, while achieving an optimal level of self-care and to coordinate discharge arrangements when clinically appropriate.

4.1. All nursing home facilities in VA’s CNH program must have the following:

4.1.1. Current Center for Medicare and Medicaid Services (CMS) certification (Medicare and/or

Medicaid) and a State nursing home license.

4.1.2. Current and unrestricted State/Federal nursing home licensure and certification.

4.1.3. Liability insurance and must be maintained and available for review.

4.2. VA developed quality of care standards utilizing CMS inspection criteria that are followed by

VA in its selection of nursing homes which includes exclusionary criteria on which the CNH is evaluated. See VHA Handbook 1143.2, “VHA Community Nursing Home Oversight

Procedures (June 4, 2004) a copy of which is available at:

http://www.va.gov/vhapublications/publications.cfm?pub=2.

4.3. VA CNH Program often has a particular need for specialty level of care services. The VA requires CNHs to have bed capacity and capability to accept VA authorized referrals in a timely fashion (ideally within 24 hours of request).

http://www.va.gov/vhapublications/publications.cfm?pub=2

4.4. Provider visits will be available at the rate of one (1) visit per month; other services such as laboratory, x-ray, and other special services will be available to VA patients as needed.

Additionally, inclusive authorization of care provided without extra charge will include the following: room, medications, meals, nursing care, provider visits as needed and other services/supplies commensurate with the VA-authorized level of care, as specified in the

Schedule of Items of this IDIQ.

4.5. Duly authorized representatives of VA will conduct visits to the CNH in order to provide continuity of care and quality oversight VA placed veterans and to assist in the veterans’ transition back into the community. These visits do not substitute nor alleviate the CNH’s contracted responsibility for the daily care and medical treatment of the veteran.

4.6. The per diem rate(s) established in this IDIQ will include the cost of primary medical care, at a minimum one (1) provider visit per month (including needed consultation, medications and routine supplies, laboratory, x-ray, and other VA authorized specialty services, unless otherwise and specifically excluded). See the Schedule of Items for details regarding the per diem rates, inclusions and exclusions. Every effort will be made to help patients achieve and maintain the highest possible quality of life. CNH staff shall direct their full attention to keeping the patients’ ambulatory as well as educating and motivating patients to achieve and maintain independence in the activities of daily living (ADL) as well as the optimal level of self-care.

5. 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.

6. 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.

7. 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. 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.

8. 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).

9. 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.

9.1. 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.

9.2. 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.

10. 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.

11. 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.

12. 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 VAPAHCS CNH Program

Coordinators at 650-493-5000, ext. 65998 Palo Alto campus or 650-493-5000, ext. 62207 Palo Alto campus. 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 shall make all final determinations as to the Contractor’s reasonable cooperation with VA and compliance with these requirements.

13. 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:

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

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

13.3. 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;

13.4. 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

13.5. Provide dates when corrective action will be completed.

14. 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:

14.1. 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;

14.2. 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;

14.3. 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

14.4. 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.

15. 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.

16. 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.

16.1. 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-ours 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.

16.2. 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.

16.3. 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.

17. 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 Coordinators based on individual patient needs but are generally limited to two (2) times per month and should be pre-approved. VA will cover bed holds based on the following plan:

17.1. The number of covered bed-hold days shall be determined by the CNH Coordinators on a case-by-case basis.

17.2. 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.

18. Reportable Events (QASP Indicator #4). VA requires CNHs to report to the CNH Coordinator at

VA any of the following events within 24-hours or immediately the first business day after a weekend or holiday:

18.1. Sentinel events;

18.1.1. When there is a change of ownership of the CNH;

18.1.2. When there is a change of nursing home administrator or Director of Nursing/Director of

Nursing Service;

18.1.3. substantiated allegations of mistreatment, neglect, abuse or misappropriation of CNH veterans or property;

18.1.4. Elopements of CNH veterans pursuant to state regulations;

18.1.5. Infectious outbreaks;

18.1.6. Resident to resident or resident to staff altercations involving a CNH veteran resulting in any injury that is other than minor;

18.1.7. Copies of annual surveys or substantiated complaint investigations conducted by a State oversight agency; and

18.1.8. Adverse events. Reporting shall include date of occurrence and patient disposition and outcome.

18.2. A sentinel event may include, but is not limited to the following:

18.2.1. A fall resulting in death or injury;

18.2.2. Elopement resulting in a missing patient;

18.2.3. Patient abuse confirmed or under suspicion;

18.2.4. A medication error resulting in patient illness or injury;

18.2.5. Death or patient injury related to restraint (including side rails) use; or

18.2.6. Death related to an unconfirmed or suspicious cause.

18.3. When an adverse event occurs involving a CNH Veteran which is not determined to be a

Sentinel Event (but that the State requires that the occurrence be reported to the State), such event is also to be reported to VA’s CNH program office. Some adverse events, such as minor medication errors without catastrophic outcomes, are managed by the CNH in the context of their quality improvement programs. It is not necessary for nursing homes to report such incidents to the CNH program office.

19. 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:

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

19.2. Suspend placement of veterans in the CNH;

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

19.4. Not renew the IDIQ; and/or

19.5. Terminate the IDIQ.

20. VA Staff Access to CNH Records (QASP Indicator #5). All medical records concerning the veteran’s care in the CNH will be readily accessible to VA. 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:

21. VAHCS Referral Package to the CNH:

21.1. Copy of Physician Orders for Nursing Home Care; CPRS Notes; Discharge Summary including History & Physical information with Medication List; Rehabilitation Progress Notes;

and Veteran Demographic Record which includes next of kin information.

21.2. Copy of Authorization Agreement (VA 10-7078).

22. 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:

22.1. Sufficient information to identify the resident;

22.2. A record of the veteran’s assessments, including those assessments performed by services under the IDIQ with the CNH;

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

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

22.5. Medical practitioner orders which are signed and dated;

22.6. Allergies;

22.7. Person to contact in an emergency situation;

22.8. Name of attending medical practitioner; and

22.9. Advanced directives if available.

23. 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.

24. 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.

25. 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 resource 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 include the hours being requested and 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.

26. 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.

27. 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. 25.1. 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.

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

27.1.1. 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.

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

28. VA Health Care System Consultation/Resources.

28.1. Telephone Care Program (TCP): For urgent same-day outpatient specialty care or for non-urgent scheduled clinic appointments/consultations, phone 1-800-455-0057 between 8 a.m. and

4 p.m. Monday through Friday, excluding holidays. If a same-day appointment is anticipated;

please call as early as possible.

28.2. Admissions/Transfer:

28.2.1. For non-emergency medical consultation or evaluation for admission to the VAPAHCS call Admissions/Transfer RN at 650-493-5000, ext. 65185 Palo Alto campus (after initial evaluation or intervention by the nursing home physician).

28.2.2. For non-emergency or emergency mental health consultation or evaluation for admission to the VAPAHCs call Mental Health Emergency Consultation at 650-493-5000, ext.

65577 Palo Alto campus.

28.3. After hours, weekends and holidays: For urgent referrals or consultation contact the

VAPAHCS Emergency Department at 650-493-5000, ext. 65470 Palo Alto campus.

28.4. Transportation: Necessary transportation to and from VA authorized appointments will be arranged and paid by the VA hospital for CNH patients when requested. Call VAPAHCS

Travel office at 650-493-500, ext. 65686

29. Charitable Contributions. The CNH will not solicit contributions, donations, or gifts from patients or family members. Note: Established charitable fundraising activities of a CNH fall outside the scope of this language.

30. CNH Billing (QASP Indicator #6). Invoices for nursing care and ancillary services shall be submitted promptly to the authorizing facility by the 15th calendar day following the end of the month in which services were rendered. The CNH will promptly notify the VA CNH Coordinator or

VA authorized representative regarding any change in Veteran status: discharge, transfer, against medical advice (AMA), hospitalization, death and/or any changes in payer source and any ability to complete timely billing. All prover invoices must accurately reflect the full name and address of the

CNH and shall reflect the patient’s name, social security number, number of days billed, authorized/approved RUG category(ies), and level of care provided/established greed upon RUG rate

(s). Failure to include this information may result in delayed payment. NOTE: All invoiced services must receive prior VA authorization.

30.1. Pre-approves services billed by CMS procedures or CPT codes: All VA pre-approved services, which are provided in addition to the all-inclusive per diem rate must be billed according to CMS procedures or CPT codes. The CNH will be reimbursed based on local guidelines and VA pricing schedules as authorized by the VA.

30.2. High cost drugs: All requests for additional reimbursement for high cost medications not included in the all-inclusive per diem rate must be specifically requested by the CNH provider or authorized designee and must be specifically authorized by the VA.

30.3. Invoices: Invoices shall be sent on the CMS-1450 (red invoice). The invoices must include the same information as provided to Medicare. Payment will be made monthly, thirty (30) days in arrears, following receipt of a properly prepared invoice. A properly prepared invoice shall include the RUG level and assessment reference date. All Services provided must be itemized

(listed separately) on the invoice. Separate invoices will be submitted for each Veteran approved for services under this agreement.

30.4. Any and all corrections to the invoice must be submitted for payment of any authorized ancillary costs or changes to the original invoice. All corrected invoices must include previously approved items that are affected by the correction and should be resubmitted.

31. Minimum Quantities; VA Payment. It is impossible to determine the exact or estimated amount, which will be expended under this IDIQ. No obligation will be incurred by VA under this IDIQ, until authorizations are issued for nursing home care of specific beneficiaries. VA agrees to make payment on a timely basis for services rendered in accordance with such authorizations upon receipt of proper invoices submitted by the CNH as outlined in this IDIQ. VA will make payment for the day a recipient enters the CNH but not the day the recipient leaves a CNH unless entrance and departure are on the same day, then payment will be made for one (1) day.

32. VA Payments. Payments made by VA under any contract pursuant to this IDIQ, constitute the total cost of nursing home care. No additional charges will be billed to Medicare (with the exception of dialysis and hospice), Medicaid, or private insurance, the beneficiary or his/her family, either by the

CNH or any third-party furnishing services or supplies required for such care, unless and until specific prior authorization in writing is obtained from the VA facility authorizing placement. The patient, family and any other entitlement programs (e.g., Medicare, Medicaid, etc.) will not be billed for uncovered services or costs during the VA contract period. This constitutes double-billing and

Federal fraud.

32.1. 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.

32.2. 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 or faxed to:

32.2.1. 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

32.2.2. For patients authorized by the VA Central California Health Care System, the

Government Invoice Address is:

VA Central California Health Care System

Attn: Bobette Varela

Email: Bobette.Varela@va.gov

2615 E. Clinton Avenue

Fresno, CA 93703

32.2.3. For patients authorized by the VA Northern California Health Care System, the

Attn: Non-VA Care/Fee Service (612-04F)

201 Walnut Avenue

Mare Island, CA 94592

32.2.4. For patients authorized by the VA Pacific Islands Health Care System, the Government

Department of Veterans Affairs

Attn: GREC Center for Aging

459 Patterson Road

Honolulu, HI 96819

32.2.5. For patients authorized by the VA San Francisco Health Care System, the Government

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

32.2.6. For patients authorized by the VA Sierra Nevada Health Care System, the Government

VA Sierra Nevada Health Care System

Attn: Dixie Langus

975 Kirman Avenue

Reno NV 89502

32.2.7. For patients authorized by the VA Southern Nevada Health Care System, the

VA Southern Nevada Health Care System

Attn: Cheryl Martin

6900 N Pecos Road

Las Vegas NV 89086

SECTION C - CONTRACT CLAUSES

C.1 52.212-4 CONTRACT TERMS AND CONDITIONS—COMMERCIAL

ITEMS (OCT 2018)

(a) Inspection/Acceptance. The Contractor shall only tender for acceptance those items that conform to the requirements of this contract. The Government reserves the right to inspect or test any supplies or services that have been tendered for acceptance. The Government may require repair or replacement of nonconforming supplies or reperformance of nonconforming services at no increase in contract price. If repair/replacement or reperformance will not correct the defects or is not possible, the Government may seek an equitable price reduction or adequate consideration for acceptance of nonconforming supplies or services. The Government must exercise its post-acceptance rights—

(1) Within a reasonable time after the defect was discovered or should have been discovered; and

(2) Before any substantial change occurs in the condition of the item, unless the change is due to the defect in the item.

(b) Assignment. The Contractor or its assignee may assign its rights to receive payment due as a result of performance of this contract to a bank, trust company, or other financing institution, including any

Federal lending agency in accordance with the Assignment of Claims Act (31 U.S.C. 3727). However, when a third party makes payment (e.g.