STC Open and Continuous Solicitation Revised Counties and Instructions Amendment 36C26324R0040 0002.pdf

5. PROJECT NUMBER (if applicable)

CODE7. ADMINISTERED BY

2. AMENDMENT/MODIFICATION NUMBER

CODE

6. ISSUED BY

8. NAME AND ADDRESS OF CONTRACTOR

4. REQUISITION/PURCHASE REQ. NUMBER

9B. DATED

PAGE OF PAGES

10A. MODIFICATION OF CONTRACT/ORDER NUMBER

10B. DATED

BPA NO. 1. CONTRACT ID CODE

FACILITY CODECODE

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

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.

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)

0002 None

36C263

Department of Veterans Affairs

NETWORK 23 CONTRACTING OFFICE

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

To all Offerors/Bidders

9A. AMENDMENT OF SOLICITATION NUMBER

36C26324R0040

X

3. EFFECTIVE DATE

11 February 2025

1 2

X X

Saint Cloud VA Health Care System Open and Continuous Nursing Home Medicare-based Solicitation 36C26324R0040 Amendment 0002 - Adding Eligible Counties and Updating the contact information on the instructions at the top of Attachment 4, Medicare Pricing Schedule.

This Amendment revises the Eligible Counties list found on page 56, Section E.2, Section 2 of the original solicitation. Revised list provided on page two.This revised list represents counties in which nursing homes may potentially secure a contract under this solicitation.

This amendment revises the contact information from Diana Rosier to Todd Penkhus, todd.penkhus@va.gov on the instructions relating to the "Pricing Schedule"

Matthew Rose Contracting Officer

02 February 2024

Minneapolis Open and Continuous Nursing Home Solicitation #36C26324R0038 Amendment 0001

This Amendment revises the Eligible Counties list found on page 56, Section E.2, Section 2 of the original solicitation.

The Revised list can be found below. This list represents counties eligible for potential award under the solicitation. Items added to the list by this amendment are listed in bold.

Saint Cloud VA Health Care System Eligible Nursing Home Counties

County State Homes Needed

Douglas 1 Meeker 1 Morrison 1 Pope 1 Sterns 1

MN

MN

MN

MN

MN

Benton Sherburne

MN

MN

Medicare RUGS IV Pricing Schedule

LINE

ITEM

RUGS IV CATEGORY

DESCRIPTION

Medicare Base Rate

Percentage Discount

Medicare Per Diem Rate

1 RUX – Extensive Services criteria + RU Criteria – ADL 16-18

2 RUL – Extensive Services criteria + RU Criteria – ADL 7-15

3 RVX – Extensive Services criteria + RV Criteria – ADL 16-18

4 RVL - Extensive Services criteria + RV Criteria – ADL 7-15

5 RHX - Extensive Services criteria + Rehab High Criteria – ADL 13-

6 RHL- Extensive Services criteria + Rehab High Criteria – ADL 7-12

7 RMX - Extensive Services criteria + RM Criteria – ADL 15-18

8 RML - Extensive Services criteria + RM Criteria – ADL 7-15

9 RLX - Extensive Services criteria + RL Criteria – ADL 7-18

10 RUC – Special Rehab Ultra High –

ADL 16-18

11 RUB – Special Rehab Ultra High –

ADL 9-15

12 RUA – Special Rehab Ultra High –

ADL 1-8

13 RVC Special Rehab Very High –

ADL 16-18

14 RVB – Special Rehab Very High –

ADL 9-15

15 RVA – Special Rehab Very High –

ADL 1-8

16 RHC – Special Rehab High – ADL 13-18

17 RHB – Special Rehab High – ADL 8-12

18 RHA – Special Rehab High – ADL 1-7

19 RMC – Special Rehab Medium –

ADL 15-18

20 RMB – Special Rehab Medium –

ADL 8-14

Attachment 4: Medicare Pricing Schedule - Amended Instructions: If you currently have a contract with VISN 23 for this home, please use the current Medicare Base Rates from that contract and place those rates in the "Medicare Base Rate" column for each Line Item. If you do not have a contract for this home with VISN 23, please email todd.penkhus@va.gov for the current Medicare Base Rates.

Next, propose a discount rate in the "Percentage Discount" column for each Line Item.

Lastly, calculate the "Medicare Per Diem Rate column by reducing the "Medicare Base Rate" figure in each column by the applicable "Percentage Discount".

Please direct any questions to Todd Penkhus at todd.penkhus@va.gov.

21 RMA – Special Rehab Medium –

ADL 4-7

22 RLB Special Rehab Low – ADL 14-

23 RLA – Special Rehab Low – ADL 1-13

24 ES3 – Extensive Services – ADL 2-

25 ES2 – Extensive Services – ADL 2-

26 ES1 – Extensive Services – ADL 2-

27 HE2 – Special Care High – ADL 15-16

28 HE1 – Special Care High – ADL 15-16

29 HD2 – Special Care High – ADL 11-14

30 HD1 – Special Care High – ADL 11-14

31 HC2 – Special Care High – ADL 6-

32 HC1 – Special Care High – ADL 6-

33 HB2 – Special Care High – ADL 2-

34 HB1 – Special Care High – ADL 2-

35 LE2 – Special Care Low - ADL 15-

36 LE1 – Special Care Low – ADL 15-

37 LD2 – Special Care Low – ADL 11-

38 LD1 – Special Care Low – ADL 11-

39 LC2 – Special Care Low – ADL 6-

40 LC1 – Special Care Low – ADL 6-

41 LB2 – Special Care Low – ADL 2-5

42 LB1 – Special Care Low – ADL 2-5

43 CE2 – Clinically Complex – ADL 15-16

44 CE1 – Clinically Complex – ADL 15-16

45 CD2 – Clinically Complex – ADL 11-14

46 CD1 – Clinically Complex – ADL 11-14

47 CC2 – Clinically Complex – ADL 6-

48 CC1 – Clinically Complex – ADL 6-

49 CB2 – Clinically Complex – ADL 2-

50 CB1 – Clinically Complex – ADL 2-

51 CA2 – Clinically Complex – ADL 0-1

52 CA1 – Clinically Complex – ADL 0-1

53 BB2 – Behavior Symptoms – ADL 2-5

54 BB1 – Behavior Symptoms – ADL 2-5

55 BA2 – Behavior Symptoms – ADL 0-1

56 BA1 – Behavior Symptoms – ADL 0-1

57 PE2 – Physical Function Reduced

– ADL 15-16

58 PE1 – Physical Function Reduced

– ADL 15-16

59 PD2 – Physical Function Reduced

– ADL 11-14

60 PD1 – Physical Function Reduced

– ADL 11-14

61 PC2 – Physical Function Reduced

– ADL 6-10

62 PC1 – Physical Function Reduced

– ADL 6-10

63 PB2 – Physical Function Reduced

– ADL 2-5

64 PB1 – Physical Function Reduced

– ADL 2-5

65 PA2 – Physical Function Reduced

– ADL 0-1

66 PA1 – Physical Function Reduced

– ADL 0-1