Amended Medicaid Solicitation 36C26320R0126 A0002.pdf

5. PROJECT NUMBER (if applicable)

CODE 7. ADMINISTERED BY

2. AMENDMENT/MODIFICATION NUMBER

CODE

6. ISSUED BY

8. NAME AND ADDRESS OF CONTRACTOR

4. REQUISITION/PURCHASE REQ. NUMBER 3. EFFECTIVE DATE

9A. AMENDMENT OF SOLICITATION NUMBER

9B. DATED

PAGE OF PAGES

10A. MODIFICATION OF CONTRACT/ORDER NUMBER

10B. DATED

BPA NO. 1. CONTRACT ID CODE

FACILITY CODE CODE

Offers must acknowledge receipt of this amendment prior to the hour and date specified in the solicitation or as amended, by one of the following methods:

The above numbered solicitation is amended as set forth in Item 14. The hour and date specified for receipt of Offers

E. IMPORTANT:

is extended,

(a) By completing Items 8 and 15, and returning __________ copies of the amendment; (b) By acknowledging receipt of this amendment on each copy of the offer submitted; or (c) By separate letter or electronic communication which includes a reference to the solicitation and amendment numbers. FAILURE OF YOUR ACKNOWLEDGMENT TO BE RECEIVED AT THE PLACE DESIGNATED FOR THE RECEIPT OF OFFERS PRIOR TO THE HOUR AND DATE SPECIFIED MAY is not extended.

12. ACCOUNTING AND APPROPRIATION DATA

(REV. 11/2016)

is required to sign this document and return ___________ copies to the issuing office. is not, A. THIS CHANGE ORDER IS ISSUED PURSUANT TO: (Specify authority) THE CHANGES SET FORTH IN ITEM 14 ARE MADE IN THE CONTRACT ORDER NO. IN ITEM 10A.

15C. DATE SIGNED

B. THE ABOVE NUMBERED CONTRACT/ORDER IS MODIFIED TO REFLECT THE ADMINISTRATIVE CHANGES SET FORTH IN ITEM 14, PURSUANT TO THE AUTHORITY OF FAR 43.103(b).

RESULT IN REJECTION OF YOUR OFFER. If by virtue of this amendment you desire to change an offer already submitted, such change may be made by letter or electronic communication, provided each letter or electronic communication makes reference to the solicitation and this amendment, and is received prior to the opening hour and date specified.

C. THIS SUPPLEMENTAL AGREEMENT IS ENTERED INTO PURSUANT TO AUTHORITY OF:

D. OTHER

Contractor

16C. DATE SIGNED

14. DESCRIPTION OF AMENDMENT/MODIFICATION

16B. UNITED STATES OF AMERICA

15A. NAME AND TITLE OF SIGNER 16A. NAME AND TITLE OF CONTRACTING OFFICER

15B. CONTRACTOR/OFFEROR

STANDARD FORM 30 PREVIOUS EDITION NOT USABLE

Prescribed by GSA - FAR (48 CFR) 53.243

(Type or print) (Type or print)

(Organized by UCF section headings, including solicitation/contract subject matter where feasible.)

(Number, street, county, State and ZIP Code)

(If other than Item 6)

(Specify type of modification and authority)

(such as changes in paying office, appropriation date, etc.)

(If required)

(SEE ITEM 11)

(SEE ITEM 13)

(X)

CHECK

ONE

13. THIS ITEM APPLIES ONLY TO MODIFICATIONS OF CONTRACTS/ORDERS,

IT MODIFIES THE CONTRACT/ORDER NO. AS DESCRIBED IN ITEM 14.

11. THIS ITEM ONLY APPLIES TO AMENDMENTS OF SOLICITATIONS

AMENDMENT OF SOLICITATION/MODIFICATION OF CONTRACT

(Signature of person authorized to sign) (Signature of Contracting Officer)

1 80

0002 10-28-2021 None

36C263

Department of Veterans Affairs

NETWORK 23 CONTRACTING OFFICE

316 Robert Street N. STE. 506 St. Paul MN 55101

To all Offerors/Bidders

36C26320R0126 0001

05-04-2021 X

This Amendment implements the following revisions to the Solicitation:

Andrew J. Schoenecker Contracting Officer

X 1

X

X

1.Updates the list of active Nursing Home needed counties in the Instructions to Offerors Addendum(see pages 51-54), 2.Adds FAR 52.223-99 at C.7 and VHA Supplemental Contract Requirements at C.8 as required by Executive Order 14042, 3.Implements formatting and spelling corrections throughout the document, 4.Updates the NARA Language at B.3, 5.Clarifies that minimum and maximum contract value will vary depending on each individual IDIQ (See B.4,#8 and C.3), 6.Revises and clarifies the Instructions to Offerors at the Addendum to E.1.

Please see see proposal submission step-by-step instructions on page 56 for further guidance.

Except as provided herein, all terms and conditions of the document referenced in Item 9A or 10A, as heretofore changed, remains unchanged and in full force and effect.

Please use fully this revised Solicitation document for all proposal submissions.

36C26320R0126 A0002

Table of Contents Section B- Continuation of SF 1449 Blocks B.1 Contract Administration Data B.2 Performance Work Statement B.3 Records Management Obligations (NARA Language) (JUL 2019) B.4 Schedule of Items

Section C- Contract Clauses C.1 52.212-4 Contract Terms and Conditions- Commercial Items (Oct 2018) C.2 52.216-18 Ordering (Aug 2020) 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 52.219-4 Notice of Evaluation Preference for HUBZone Small Business Concerns (Deviation 2019-01) C.7 52.223-99 Ensuring Adequate COVID-19 Safety Protocols for Federal Contractors (Deviation Oct 2021) C.8 FAR 52.223-99 Addendum: VHA Supplemental Contract Requirements for Ensuring Adequate COVID-19 Safety Protocols for Federal Contractors (Oct 2021) C.9 52.232-40 Providing Accelerated Payments to Small Business Subcontractors (Deviation Aug 2020) C.10 VAAR 852.212-70 Provisions and Clauses Applicable to VA Acquisition of Commercial Items (Apr 2020) C.11 VAAR 852.216-71 Economic Price Adjustment of Contract Price(s) Based on a Price Index (Mar 2018) C.12 VAAR 852.219-74 Limitations on Subcontracting—Monitoring and Compliance (Jul 2018) C.13 VAAR 852.219-75 Subcontracting Commitments Monitoring and Compliance (Jul 2018) C.14 52.252-2 Clauses Incorporated by Reference (Feb 1998) C.15 VAAR 852.252-70 Solicitation Provisions or Clauses Incorporated by Reference (JAN 2008) C.16 52.212-5 Contract Terms and Conditions Required to Implement Statutes or Executive Orders— Commercial Items (Nov 2020) C.17 Mandatory Written Disclosures

Section D – Contract Documents, Exhibits, or Attachments

Section E- Solicitation Provisions E.1 52.212-1 Instructions to Offerors— Commercial Items (Jun 2020) E.2 52.204-24 Representation Regarding Certain Telecommunications and Video Surveillance Services or Equipment (Oct 2020) E.3 52.209-7 Information Regarding Responsibility Matters (Oct 2018) E.4 52.216-1 Type of Contract (Apr 1984) E.5 52.233-2 Service of Protest (Sep 2006) E.6 52.252-1 Solicitation Provisions Incorporated by Reference (Feb 1998) E.7 52.212-2 Evaluation- Commercial Items (Oct 2014) E.8 52.212-3 Offeror Representations and Certifications- Commercial Items (Nov 2020)

Section B- Continuation of SF 1449 Blocks B.1 Contract Administration Data

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

a. CONTRACTOR:

b. GOVERNMENT: Contracting Officer 36C263 Department of Veterans Affairs

NETWORK 23 CONTRACTING OFFICE

316 Robert Street N. STE. 506 St. Paul MN 55101

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

Department of Veterans Affairs Financial Services Center PO Box 149971 Austin TX 78714-9971

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

AMENDMENT NO DATE

A0001 4 May 2021 A0002 28 Oct 2021

B.2 Performance Work Statement

A. Overview

1. Federal Acquisition Regulation (FAR) – Indefinite Delivery Indefinite Quantity Contract

(IDIQ). In accordance with FAR 16.504, Indefinite-Quantity Contracts, this is a IDIQ for the time period from the “Award Date” for one (1) 5-year ordering period with a 6-month option to extend at the sole discretion of the Government.

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, Attachment 3, RUGs IV Levels of Care, 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. Referrals to CNHs and placements. VA acknowledges that, depending on the availability of resources at specific IDIQ holder facilities at specific times, acceptance of a referral may be commercially impracticable for the IDIQ holder. Commercial or situational impracticability (e.g., facilities must be able to perform pre-admission screenings; assess whether the nursing home has beds open and appropriate beds; are able to meet care needs based on number of staff and possess the clinical expertise to manage Veterans care; have the appropriate room (private or shared); can manage certain behaviors (like wandering if they don’t have a secure unit); and have the ability to decline based on criminal records, etc.). In that event, the IDIQ holder may decline to accept an authorization. If the IDIQ holder has determined that space is not available and will not accept the Veteran, the CNH program personnel will seek another IDIQ contract and an authorization will be issued when a match is found.

Designated CNH program personnel will issue written authorizations for Veterans to the IDIQ holder. In accordance with FAR 16.505(b)(2)(i)(A) or FAR 16.505(b)(2)(i)(B), VA has determined it is in the best interest of the Veteran to place the individual order without further competition because the need for these services is sometimes urgent,and providing the opportunity to all IDIQ holders or other vendors would result in unacceptable delays in fulfilling that need. Location primarily will be selected based on the Veteran’s needs and proximity to the Veteran’s home.

B. Background

1. Introduction. The Community Nursing Home (CNH) program is a key component of the

Veterans Health Administration (VHA) continuum of care. The Contractor agrees to provide in accordance with the terms and conditions stated herein to the U.S. Department of Veterans Affairs [Site] Health Care System, in [City, State] 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 Veteran is rendered.

C. Requirements

1. General. Nursing home facilities in the CNH program shall ensure that care meets the health needs and promotes the maximum well-being of Veterans. Nursing home care will be furnished to ensure the total medical, nursing, and psychosocial needs of VA beneficiaries.

All nursing home facilities in VA’s CNH program must have current Center for Medicare and Medicaid Services (CMS) certification (Medicare and/or Medicaid) and a State nursing home license. VA developed quality of care standards utilizing CMS inspection criteria that are followed by VA in its selection of nursing homes and annual and ongoing quality reviews. 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. (The CNH also must be able to accept VA referrals within 24 hours of request). Primary care/provider (medical doctor, nurse practitioner, and/or physician assistant) visits will be available at the Medicaid frequency requirements. Laboratory, x-ray, and other special services will be available to Veterans as needed. In addition, the care provided will include room, meals, nursing care, and other services or supplies commensurate with the VA-authorized level of care, without extra charge.

Authorized VA representatives will provide quality oversight visits to Veterans to assure satisfaction, quality, and continuity of care and may assist in the Veterans’ transition back into the community, when applicable.

These visits do not substitute nor relieve the CNH in any way of the responsibility for the daily care and medical treatment of the Veteran. The per diem rate(s) established in this IDIQ will include the cost of nursing care, room and board, meals, primary medical care which includes provider visits, drugs and routine supplies, laboratory, x-ray, and other special services authorized by VA, unless otherwise specifically excepted (see Schedule of Items in this IDIQ for details regarding per diem rates and coverage).

Full attention shall be given to motivating and educating Veterans to achieve and maintain independence in the activities of daily living. Each Veteran must receive, and the facility must provide the necessary care and services to attain or maintain the highest practicable physical, mental, and psychosocial well-being, in accordance with the comprehensive assessment and plan of care. Every effort shall be made to keep patients ambulatory and to achieve an optimal level of self-care.

2. Termination of Services. VA reserves the right to remove any or all Veterans from the CNH at any time when it is determined to be in the best interest of VA or the Veterans without additional costs to the Government.

3. VA Authorizations. Authorization for nursing home care will be issued to the facility per written VA authorization. Each authorization validity period will be noted on the order with a beginning and end date. Any extension to the original authorization validity period, regardless of the number of days, requires a new authorization.

NOTE: During the time period of this contract, the Medicaid payment method below MAY change to Patient Driven Patient Method (PDPM) or another system. See, also, Schedule of Items in section B.4 of this contract.

4. Medicaid-Based Rates. The VA rate will include medical care, routine medications, laboratory, x-ray, therapy, 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 reference. 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 Veteran care; arranging easy access to staff for consultation; providing timely response to calls and arranging for timely provider back-up according to the Omnibus Budget Reconciliation Act (OBRA), also known as the Nursing Home Reform Act of 1987, guidelines (42 CFR 483.30, OBRA Guidelines).

6. Rehabilitation Criteria. All therapy provided will be individual therapy, rather than group therapy, unless otherwise ordered by the authorizing VA facility. Therapy evaluation must be completed and sent to the VA CNH office for approval of services. 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 Medicaid criteria.

a. 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.

b. Evaluations/re-evaluations should consider the following: Establishment of treatment goals specific to the Veteran’s disability or dysfunction and designed to specifically address each problem identified in the evaluation; design of a plan of care addressing the Veteran’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 Veteran and family training to augment rehabilitative treatment or establish a maintenance program. Education of staff and family should be ongoing.

7. Emergency Care; Financial Responsibility; Advanced Directives. In emergencies, nursing home staff will utilize the 911 local emergency systems as for any resident. Advance directives or living wills shall be adhered to according to CNH physician’s orders. When private hospitalization or emergency services are required, the patient, spouse, financial guardian or insurer is financially responsible. Service-connected Veterans may qualify for VA coverage of emergency care provided the VA Medical Center (VA) is contacted by the private hospital provider within 72 hours of admission on the first business day following a weekend or holiday. This includes the cost of necessary transportation for such care.

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

9. State Licensure; Access to CNH Quality of Care Reports (QASP Indicator #1). The CNH must maintain a current and unrestricted state license to operate as a skilled nursing facility. Changes in the status of the licensure will be immediately reported to the [SITE] Home and Community Care Department at [PHONE #]. VA will monitor the professional care and administrative management of services provided to VA beneficiaries, 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 Veterans. 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, 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.

10. Corrective Action Plan (QASP Indicator #2): The CNH will cooperate with timely development of Corrective Action Plans (CAPs) related to identified deficiencies and related to State, Federal or VA annual reviews. The CNH will develop in the time period specified by VA timely and appropriate CAPs for VA annual reviews or investigation of complaints related to quality of care or sentinel events. The CNH will also supply related documents or data as specified by VA. The CAPs will include but are not limited to the following criteria and shall:

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

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

c. Include the measures the CNH will take or systems that will be altered to ensure that the problem will not recur. The CNH must look at the system and determine if a change to the existing system will work, if a new system is necessary, or if a system does not exist and must be developed.

d. Indicate how the CNH plans to monitor performance to make sure that solutions are permanent. The CNH must develop a quality assurance tool for ensuring that correction is achieved and sustained. This tool must be implemented. Failure to implement a quality assurance tool to sustain compliance will reflect that the CNH has an ineffective quality assurance system.

e. Provide dates when corrective action will be completed.

11. 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 Medical Center (VA), as authorized by VA.

a. When such an admission is not feasible because of the nature of the emergency, hospitalization in a non-Federal facility may be accomplished provided VA authorization is obtained. VA authorization must be obtained within 72 hours of admission of the Veteran to a non-Federal facility. If hospitalization of a non-emergency nature is required, readmission to a VA Medical Center may be accomplished as soon as the Veteran’s condition is sufficiently stabilized to permit admission to a VA.

b. In the event of a death of a VA beneficiary, while receiving nursing home care, the CNH will promptly notify the VA facility which authorized admission and immediately assemble, inventory, and safeguard the Veteran’s personal effects. The funds, deposits, and effects left by the VA Veterans 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 Veterans, unless the beneficiary died without leaving a will, heirs or next of kin capable of inheriting.

c. Should a deceased Veteran 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 itemized inventory with annotation as to the disposition of the funds and effects of any such property and funds in its possession to the VA facility of jurisdiction 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 nursing home records for five (5) years when there is no requirement in State law.

12. Bed-Hold Policy for hospitalizations and approved therapeutic passes.

Hospitalizations do not require a pre-authorization, but VA must be notified as soon as possible (no later than one business day after hospitalization). Therapeutic passes are to be limited and pre-authorized by the VA.

a. Hospitalizations. The first two days of hospitalization reimbursed at 70% of the current per diem rate.

b. Therapeutic Passes(pre-authorized only). Two days per month, reimbursed at 70% of the current per diem rate, if prior authorization is received from the local VA.

Bed-hold begins the date the Veteran departs the CNH and the current per diem rate resumes the date of readmission. Absences of fifteen (15) consecutive days requires the VA to discharge the Veteran from the current CNH authorization. A new authorization is required upon readmission to a CNH. The CNH is responsible to notify the Veteran / family of any financial responsibility for bed hold days not paid by the VA, arrangements may then be made between the Veteran / family and the CNH beyond the VA authorized (two) days.

13. Reportable Events (QASP Indicator #3).

a. 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:

1) Sentinel events. (see d. below)

2) Substantiated allegations of mistreatment, neglect, abuse or misappropriation of CNH Veterans or property

3) Elopements of CNH Veterans pursuant to state regulations.

4) Infectious outbreaks.

5) Resident to resident or resident to staff altercations involving a CNH Veteran resulting in any injury that is other than minor;

6) Copies of annual surveys or substantiated complaint investigations conducted by a State oversight agency.

7) Adverse events.

b. Reporting shall be in writing and include date of occurrence and Veteran disposition and outcome.

c. Other Reportable Events that should be reported timely, but not necessarily immediately include:

1) Any Change of nursing home Administrator or Director of Nursing / Director of Nursing Service.

2) Any pending change of ownership of the CNH.

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

1) A fall resulting in death or injury.

2) Elopement resulting in a missing resident.

3) Resident abuse confirmed or under suspicion.

4) A medication error resulting in resident illness or injury.

5) Death or resident injury related to restraint (including side rails) use.

6) Death related to an unconfirmed or suspicious cause.

e. 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.

14. 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:

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

b. Suspend placement of Veterans in the CNH.

c. Remove or transfer Veterans under the IDIQ from the subject CNH.

d. Not renew the IDIQ.

e. Terminate the IDIQ.

15. VA Staff Access to CNH Records (QASP Indicator #4). All medical records concerning the Veteran’s care in the CNH will be readily accessible to VA. Upon discharge or the death of a Veteran, medical records will be retained by the CNH for a period of at least five (5) years following termination of care. Veteran records will be maintained in conformance with the Privacy Act of 1974 (5 U.S.C. § 552a). VA will have remote access to records for offsite review. A medical record shall be maintained for each Veteran, which includes at least the following:

a. VA Referral Package to the CNH: This consists of:

1) Copy of Physician Orders for Nursing Home Care.

2) CPRS Notes.

3) Discharge Summary Including History and Physical information with Medication List.

4) Rehabilitation Progress Notes.

5) Veteran Demographic Record which includes next of kin information.

b. Copy of authorization.

c. Nursing Home Clinical Record: The CNH must maintain clinical records on each

Veteran in accordance with accepted professional standards and practice. The clinical record must be: complete, accurately documented, readily accessible, systematically organized, and legible. Clinical records must contain at a minimum:

1) Sufficient information to identify the resident.

2) A record of the Veteran’s assessments, including those assessments performed by services under the IDIQ with the CNH.

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

4) Interdisciplinary progress notes to include effect of care provided, Veterans’ response to treatment, change in condition, and changes in treatment.

5) Medical practitioner orders which are signed and dated.

6) Allergies.

7) Person to contact in an emergency situation.

8) Name of attending medical practitioner.

9) Advanced directives as available.

d. 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.

16. Specialty Services. The CNH will assume responsibility for arranging specialty care for Veterans (e.g., dental care or ophthalmology).

17. VA Medical Center Consultation/Resources (This section will be tailored with appropriate information for each Contract prior to Award).

a. Telephone Care Communications Systems (TCCS): For urgent same-day outpatient specialty care or for non-urgent scheduled clinic appointments/consultations, [PHONE #] between 9 a.m. and 3 p.m. Monday through Friday, excluding holidays. If a same-day appointment is anticipated;

please call as early as possible.

b. Admissions Conference Call System phone number: [PHONE #]. For non-emergency consultation or /evaluation for admission to the [FACILITY/SITE NAME] (after initial evaluation or intervention by the nursing home physician).

c. After hours, weekends and holidays: For urgent referrals or consultation contact the Admission Conference Call System number [PHONE #].

d. Transportation: Necessary transportation to and from the VA hospital for clinics, evaluation or hospitalization will be arranged and MAY BE paid by the VA hospital for CNH patients when requested. For clinic appointments, call [PHONE #].

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

19. CNH Billing. Invoices for board, care and ancillary services shall be submitted promptly to the authorizing facility after generation of State Medicaid Case Mix Classification and not later than 30 days following the end of the month in which services were rendered. The CNH will promptly notify the VA CNH program 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 invoices must include the full name and address of the CNH and shall reflect the Veteran’s name, social security number, number of days billed, RUG category(ies), and agreed upon RUG rate (s). Failure to include this information may result in delayed payment.

a. Pre-approved services billed by CMS procedures or CPT codes: All services which are pre-approved by VA as additional 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.

b. High-cost drugs: All requests for additional reimbursement for high cost drugs and corresponding billing are due as soon as possible, but no later than 90 calendar days after use of products.

c. Invoices: Corrected invoices must be submitted whenever it is found that the original invoice was not correct. All corrected invoices must include all items that are affected by the change.

20. Minimum Quantities; VA Payment. It is impossible to determine the exact or estimated amount, which will be expended under this IDIQ. Only the minimum guarantee 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 Veteran enters the CNH but not the day the Veteran leaves a CNH unless entrance and departure are on the same day, then payment will be made for one (1) day.

21. 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 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 is obtained from the VA facility authorizing placement. The Veteran, 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. Should Veteran / family choose to have a service not authorized by VA, i.e. private room when double room available or therapy when VA has reviewed and deemed not medically indicated, the CNH will first contact VA to insure the service is not covered by VA, then make arrangements with Veteran / family for private pay. Invoicing will be conducted electronically.

The contractor, their personnel, and their subcontractors shall be subject to the Federal laws, regulations, standards, and VA Directives and Handbooks regarding information and information system security as delineated in this contract.

END PERFORMANCE WORK STATEMENT

B.3 Records Management Obligations (NARA Language) (JUL 2019) Website: https://www.archives.gov/records-mgmt/policy/records-mgmt-language

RECORDS MANAGEMENT OBLIGATIONS

A. Applicability This clause applies to all Contractors whose employees create, work with, or otherwise handle Federal records, as defined in Section B, regardless of the medium in which the record exists.

B. Definitions “Federal record” as defined in 44 U.S.C. § 3301, includes all recorded information, regardless of form or characteristics, made or received by a Federal agency under Federal law or in connection with the transaction of public business and preserved or appropriate for preservation by that agency or its legitimate successor as evidence of the organization, functions, policies, decisions, procedures, operations, or other activities of the United States Government or because of the informational value of data in them. The term Federal record:

1. Includes [Agency] records.

2. Does not include personal materials.

3. Applies to records created, received, or maintained by Contractors pursuant to their

[Agency] contract

4. May include deliverables and documentation associated with deliverables.

C. Requirements

1. Contractor shall comply with all applicable records management laws and regulations, as well as National Archives and Records Administration (NARA) records policies, including but not limited to the Federal Records Act (44 U.S.C. chs. 21, 29, 31, 33), NARA regulations at 36 CFR Chapter XII Subchapter B, and those policies associated with the safeguarding of records covered by the Privacy Act of 1974 (5 U.S.C. 552a).

These policies include the preservation of all records, regardless of form or characteristics, mode of transmission, or state of completion.

2. In accordance with 36 CFR 1222.32, all data created for Government use and delivered to, or falling under the legal control of, the Government are Federal records subject to the provisions of 44 U.S.C. chapters 21, 29, 31, and 33, the Freedom of Information Act (FOIA) (5 U.S.C. 552), as amended, and the Privacy Act of 1974 (5 U.S.C. 552a), as amended and must be managed and scheduled for disposition only as permitted by statute or regulation.

3. In accordance with 36 CFR 1222.32, Contractor shall maintain all records created for Government use or created in the course of performing the contract and/or delivered to, or under the legal control of the Government and must be managed in accordance with Federal law. Electronic records and associated metadata must be accompanied by sufficient technical documentation to permit understanding and use of the records and data.

4. [Agency] and its contractors are responsible for preventing the alienation or unauthorized destruction of records, including all forms of mutilation. Records may not be removed from the legal custody of [Agency] or destroyed except for in accordance with the provisions of the agency records schedules and with the written concurrence of the Head of the Contracting Activity. Willful and unlawful destruction, damage or alienation of Federal records is subject to the fines and penalties imposed by 18 U.S.C.

2701. In the event of any unlawful or accidental removal, defacing, alteration, or https://www.archives.gov/records-mgmt/policy/records-mgmt-language destruction of records, Contractor must report to [Agency]. The agency must report promptly to NARA in accordance with 36 CFR 1230.

5. The Contractor shall immediately notify the appropriate Contracting Officer upon discovery of any inadvertent or unauthorized disclosures of information, data, documentary materials, records or equipment. Disclosure of non-public information is limited to authorized personnel with a need-to-know as described in the [contract vehicle]. The Contractor shall ensure that the appropriate personnel, administrative, technical, and physical safeguards are established to ensure the security and confidentiality of this information, data, documentary material, records and/or equipment is properly protected. The Contractor shall not remove material from Government facilities or systems, or facilities or systems operated or maintained on the Government’s behalf, without the express written permission of the Head of the Contracting Activity.

When information, data, documentary material, records and/or equipment is no longer required, it shall be returned to [Agency] control or the Contractor must hold it until otherwise directed. Items returned to the Government shall be hand carried, mailed, emailed, or securely electronically transmitted to the Contracting Officer or address prescribed in the [contract vehicle]. Destruction of records is EXPRESSLY PROHIBITED unless in accordance with Paragraph (4).

6. The Contractor is required to obtain the Contracting Officer's approval prior to engaging in any contractual relationship (sub-contractor) in support of this contract requiring the disclosure of information, documentary material and/or records generated under, or relating to, contracts. The Contractor (and any sub-contractor) is required to abide by Government and [Agency] guidance for protecting sensitive, proprietary information, classified, and controlled unclassified information.

7. The Contractor shall only use Government IT equipment for purposes specifically tied to or authorized by the contract and in accordance with [Agency] policy.

8. The Contractor shall not create or maintain any records containing any non-public [Agency] information that are not specifically tied to or authorized by the contract.

9. The Contractor shall not retain, use, sell, or disseminate copies of any deliverable that contains information covered by the Privacy Act of 1974 or that which is generally protected from public disclosure by an exemption to the Freedom of Information Act.

10. The [Agency] owns the rights to all data and records produced as part of this contract.

All deliverables under the contract are the property of the U.S. Government for which [Agency] shall have unlimited rights to use, dispose of, or disclose such data contained therein as it determines to be in the public interest. Any Contractor rights in the data or deliverables must be identified as required by FAR 52.227-11 through FAR 52.227-20.

11. Training. All Contractor employees assigned to this contract who create, work with, or otherwise handle records are required to take [Agency]-provided records management training. The Contractor is responsible for confirming training has been completed according to agency policies, including initial training and any annual or refresher training.

B.4 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. Items generally included or excluded in the per diem rate are listed in

Table A, although some variances may apply in coverage. The per diem rate(s) will apply throughout the term of this Indefinite Delivery Indefinite Quantity Contract (IDIQ). While the VA uses

State Medicaid rates as a reference, VA rates are independent and governed by the terms of this

IDIQ. The per diem rate utilizes the Medicaid RAI/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. The

Price Schedules are included as attachments to submit price rates with a percentage add-on to the

Medicaid base rates determined by the relevant State for the Nursing Home.

Table A

SERVICE COVERED

BY PER-DIEM

NOT

COVERED BY

PER DIEM

NOTES

Lab Tests X

Laundry/Linen service

X

Medications X Paragraph 4 of this Schedule of Items

Nursing supplies X

Occupational Therapy

X Pre-approval required(Paragraph 3) of this Schedule of Items

Oxygen Therapy X

Pastoral Care X

Physical Therapy X Pre-approval required (Paragraph 3) of this Schedule of Items

Private Room X See Paragraph 5 of this Schedule of Items

Provider visits

(MD/NP)

1 per month Pre-approval required for additional visits

Radiology Studies X

Respiratory Therapy

X

Room and Board X

Routine nursing care

X

Routine Podiatry Care

X

Social Services X

Speech Therapy X Pre-approval required(Paragraph 3) of this Schedule of Items

Therapeutic Recreational services

X

Ventilator Care X See Paragraph 6 of this Schedule of Items

Audiology Care X Pre-approval and special authorization required of this Schedule of Items

Custom Prosthetics X Pre-approval and special authorization required of this Schedule of Items

Dental Care X Pre-approval and special authorization required of this Schedule of Items

Dialysis X Pre-approval and special authorization required of this Schedule of Items

Durable medical Equipment

X Can be obtained through VA

Eye Care X Pre-approval and special authorization required of this Schedule of Items

Hospice Care X Veterans may be eligible for additional hospice program services, but must be separately authorized by VA.

Hospitalizations X Refer to Performance Work Statement (PWS) section 16(a)

Psychology Services

X Pre-approval and special authorization required of this Schedule of Items

Specialized beds X Pre-approval and special authorization required of this Schedule of Items

Specialized Wound Care

X Pre-approval and special authorization required of this Schedule of Items

TPN/IV Therapy X Pre-approval and special authorization required of this Schedule of Items

Transportation X Pre-approval and special authorization required of this Schedule of Items

UC/ER visits X Refer to Performance Work Statement (PWS) sections 9 and 16(a)

NOTE: During the time period of this contract, payment method MAY change to the Patient Driven Payment Method (PDPM) or another system.

2. Rate Adjustments: Rate adjustments are made in accordance with the proper State agency regulatory standard. Rate adjustments are not effective until the IDIQ modification is 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 modification. The VA will adjust the Medicaid Base Rate in accordance with the EPA clause incorporated into the contract via VAAR 852.216-71. The VA will provide this adjustment at most once annually, by mutual agreement.

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 according to Average Warehouse Price (AWP) or the State Medicaid rate or 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. 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 rate table and will be an all-inclusive per diem rate (including ventilator and supplies).

7. Specialized Prosthetics Equipment (e.g., special bed and/or bariatric equipment):

Veterans may be eligible for specialized equipment when clinically indicated. Pre-approval required by VA.

8. Minimum and Maximum Amounts for this IDIQ. The minimum spend on this IDIQ is $50.00.

The maximum amount for this IDIQ shall not exceed $[TBD, determined for each IDIQ prior to award].

9. Other services requiring special rates. Alternative / special rates may be considered if required for specific services, such as but not limited to- ventilator rates, Alzheimer/dementia unit rates, and Traumatic Brain Injury care related rates.

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., use of the Governmentwide commercial purchase card), the Contractor may not assign its rights to receive payment under this contract.

(c) Changes. Changes in the terms and conditions of this contract may be made only by written agreement of the parties.

(d) Disputes. This contract is subject to 41 U.S.C. chapter 71, Contract Disputes. Failure of the parties to this contract to reach agreement on any request for equitable adjustment, claim, appeal or action arising under or relating to this contract shall be a dispute to be resolved in accordance with the clause at FAR 52.233-1, Disputes, which is incorporated herein by reference. The Contractor shall proceed diligently with performance of this contract, pending final resolution of any dispute arising under the contract.

(e) Definitions. The clause at FAR 52.202-1, Definitions, is incorporated herein by reference.

(f) Excusable delays. The Contractor shall be liable for default unless nonperformance is caused by an occurrence beyond the reasonable control of the Contractor and without its fault or negligence such as, acts of God or the public enemy, acts of the Government in either its sovereign or contractual capacity, fires, floods, epidemics, quarantine restrictions, strikes, unusually severe weather, and delays of common carriers.