C03 Executed Contract - 36C24626D0003 - Ash Hemodialysis.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. UEI: EFT:

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. NOV 2021)

PREVIOUS EDITION IS NOT USABLE Prescribed by GSA - FAR (48 CFR) 53.212

7. FOR SOLICITATION

INFORMATION CALL:

STANDARD FORM 1449

SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL PRODUCTS AND COMMERCIAL SERVICES

OFFEROR TO COMPLETE BLOCKS 12, 17, 23, 24, & 30

36C24626D0003 10-01-2025

Karen Crowe, Contracting Specialist 757-728-7083

Department of Veterans Affairs Network Contracting Office 6 100 Emancipation Drive Hampton VA 23667

X

Y

621492

$47 Million

N/A

X

Department of Veterans Affairs Charles George VA Medical Center 1100 Tunnel Road Asheville NC 28805-2043

Department of Veterans Affairs Network Contracting Office 6 100 Emancipation Drive Hampton VA 23667

8V5N5

RENAL TREATMENT CENTERS-MID-ATLANTIC INC

DBA Asheville Veterans Acutes 1100 Tunnel Road Asheville NC 28805

Robert Ward / 540-409-8787 Robert.Ward@davita.com

SL1BS25L8NJ9

Department of Veterans Affairs Financial Services Center

PO BOX 149971

Austin TX 78714-9971

512-460-5049 512-460-5221

1. Contractor shall provide Onsite Inpatient Acute Care Hemodialysis Services to include Registered Nurses (RNs) Ancillary Staff, and Equipment at the Charles George VA Medical Center, Asheville, NC.

2. SEE B.2: FOR THE SCHEDULE OF SERVICES

3. SEE B.3: FOR THE PERFORMANCE WORK STATEMENT (PWS)

4. Please reference PO# 637-C60028 on all invoices from 1 Oct 2025 through 30 Sept 2026.

5. Base Year Period of Performance: 1 Oct 2025 - 30 Sept 2026.

$241,930.00 Base Year Estimated 637-3660160-3059-821100-2560-C60028-0100201C4

X X X 1 (one

Mohamed M. Shakur Contracting Officer

Docusign Envelope ID: 99A1080A-ABD9-4A4C-B2D6-15E64ACF2CDD

Division Vice PresidentSeptember 24, 2025Stephen Krutko 1 Oct 2025

36C24626D0003

Table of Contents

SECTION A

A.1 SF 1449 SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL PRODUCTS AND

COMMERCIAL SERVICES

SECTION B - CONTINUATION OF SF 1449 BLOCKS

B.1 CONTRACT ADMINISTRATION DATA

B.2 SCHEDULE OF SERVICES

B.3 PERFORMANCE WORK STATEMENT

B.4 SPECIAL CONTRACT REQUIREMENTS

SECTION C - CONTRACT CLAUSES

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

AND COMMERCIAL SERVICES (NOV 2023)

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

C.3 52.204-9 PERSONAL IDENTITY VERIFICATION OF CONTRACTOR PERSONNEL

(JAN 2011)

C.4 52.204-21 BASIC SAFEGUARDING OF COVERED CONTRACTOR INFORMATION

SYSTEMS (NOV 2021)

C.5 SUPPLEMENTAL INSURANCE REQUIREMENTS

C.6 52.216-18 ORDERING (AUG 2020)

C.7 52.216-19 ORDER LIMITATIONS (OCT 1995)

C.8 52.216-22 INDEFINITE QUANTITY (OCT 1995)

C.9 52.217-8 OPTION TO EXTEND SERVICES (NOV 1999)

C.10 52.217-9 OPTION TO EXTEND THE TERM OF THE CONTRACT (MAR 2000)

C.11 52.232-19 AVAILABILITY OF FUNDS FOR THE NEXT FISCAL YEAR (APR 1984)

C.12 VAAR 852.204-71 INFORMATION AND INFORMATION SYSTEMS SECURITY

(FEB 2023)

C.13 VAAR 852.211-76 LIQUIDATED DAMAGES – REIMBURSEMENT FOR DATA

BREACH COSTS (FEB 2023) ALTERNATE I (FEB 2023)

C.14 VAAR 852.219-75 VA NOTICE OF LIMITATIONS ON SUBCONTRACTING—

CERTIFICATE OF COMPLIANCE FOR SERVICES AND CONSTRUCTION (JAN 2023)

(DEVIATION)

C.15 VAAR 852.242-71 ADMINISTRATIVE CONTRACTING OFFICER (OCT 2020)

C.16 52.212-5 CONTRACT TERMS AND CONDITIONS REQUIRED TO IMPLEMENT

STATUTES OR EXECUTIVE ORDERS—COMMERCIAL PRODUCTS AND

COMMERCIAL SERVICES (JAN 2025) (DEVIATION FEB 2025)

SECTION D - CONTRACT DOCUMENTS, EXHIBITS, OR ATTACHMENTS

D.6 WAGE DETERMINATION

SECTION B - CONTINUATION OF SF 1449 BLOCKS

B.1 CONTRACT ADMINISTRATION DATA

(continuation from Standard Form 1449, block 18A.)

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

a. CONTRACTOR:

Company: Renal Treatment Centers-Mid-Atlantic, Inc. (dba DaVita Inc.)

Point of Contract - Name: Robert Ward

Title: Group Regional Operations Director Email: Robert.Ward@davita.com Phone: 540-409-8787

TIN: 232536597

UEI: SL1BS25L8NJ9

b. GOVERNMENT:

Contracting Officer Contracting Specialist Mohamed M. Shakur Karen Crowe 757-728-7013 / Mohamed.Shakur@va.gov 757-728-7083 / Karen.Crowe@va.gov Department of Veterans Affairs Department of Veterans Affairs Network Contracting Office 6 Network Contracting Office 6 100 Emancipation Drive 100 Emancipation Drive Hampton, VA 23667 Hampton VA 23667

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.

Invoicing shall be in accordance with the requirements of The Department of Veterans Affairs (VA) Financial Services Center (VAFSC). The latest information shall be used for invoicing and payments and may change during the Period of Performance of this acquisition. Current Invoicing information is located at http://www.fsc.va.gov/einvoice.asp

5. SECURE FAX: All faxes should contain the following language: “This fax is intended only for the use of the person or office to which it is addressed and may contain information that is privileged, confidential, or protected by law. All others are hereby notified that the receipt of this fax does not waive any applicable privilege or exemption for disclosure and that any dissemination, distribution, or copying of this communication is prohibited. If you have received this fax in error, please notify this office immediately at the telephone number listed on the front page of the facsimile cover page.

6. BADGES: Contractor is required to wear I.D. badge during the entire time he/she is on CGVAMC grounds. I.D. badges MUST have an identification picture and shall be issued by

CGVAMC.

7. NO SMOKING POLICY: All VHA health care facilities (including CBOCs and HCCs) are smoke-free for patients, visitors, contractors, volunteers, and vendors effective October 1, 2019. The policy applies to cigarettes, cigars, pipes, or any other combustion of tobacco, including but not limited to electronic or e-cigarettes, vape pens or e-cigars.

8. POST AWARD ORIENTATION

The Contracting Officer will schedule a post award orientation for contract orientation if necessary.

9. System updates may lag policy updates. The System for Award Management (SAM) may continue to require entities to complete representations based on provisions that are not included in agency solicitations. Examples include 52.222-25, Affirmative Action Compliance, and paragraph (d) of 52.212-3, Offeror Representations and Certifications – Commercial Products and Commercial Services. Contracting officers will not consider these representations when making award decisions or enforce requirements. Entities are not required to, nor are they able to, update their entity registration to remove these representations in SAM.

10. MANDATORY WRITTEN DISCLOSURES

Mandatory written disclosures required by FAR clause 52.203-13 to the Department of Veterans Affairs, Office of Inspector General (OIG) must be made electronically through the VA OIG Hotline at http://www.va.gov/oig/contacts/hotline.asp and clicking on "FAR clause 52.203-13 Reporting." If you are experience-difficulty accessing the website, call the Hotline at 1-800-488- 8244 for further instructions.

B.2 SCHEDULE OF SERVICES

The Contractor shall provide onsite inpatient Acute Care Hemodialysis Services to include registered nurses (RN’s) and ancillary equipment to perform all Inpatient Hemodialysis Service onsite at the Asheville Charles George VAMC (CGVAMC) of the Department of Veterans Affairs, Western North Carolina VA Health Care System (WNCHCS) in accordance with the specifications contained herein to beneficiaries of the Department of Veterans Affairs (VA).

The Government will issue a fixed price Indefinite Delivery Indefinite Quantity (IDIQ) contract for this requirement and the guaranteed minimum contract quantity, including the base year and any option year exercised is 100 procedures and the maximum quantity contract amount, including the base year and any option years exercised shall not exceed 2,000 procedures.

Place of Performance: Services shall be provided on site at the CGVAMC, 1100 Tunnel Road, Asheville, NC 28805.

The Contractor shall propose key personnel to be credentialed and be available for scheduling and ancillary equipment to meet the requirements of the contract. as defined in section B.3. below.

PERIOD OF PERFORMANCE – BASE YEAR: October 1, 2025 to September 30, 2026

LIN

No.

0BDescription of Service Estimated Qty. 5BUnit Unit Cost

Total

Annual Cost

0001 90935-Hemodialysis procedure 300 Procedure $780.00 $234,000.00

Cancellation after set-up (Labor and Supplies)

6 Procedure $175.00 $1,050.00

Treatment Cancellation Before Set-up

6 Procedure $100.00 $600.00

0004 Waiting Time (after 15 minutes per hour)

12 Procedure $75.00 $900.00

Holiday differential- per procedure 10 Procedure $100.00 $1,000.00

0006 Blood Administration 24 Procedure $75.00 $1,800.00

0007 Extra Dialyzer 12 Procedure $15.00 $180.00

0008 Equipment Culture 48 Procedure $50.00 $2,400.00

PERIOD OF PERFORMANCE – OPTION YEAR 1: October 1, 2026 to September 30, 2027

Supplies and Maintenance of equipment per week (0-5 treatments per week)

Included Procedure $0 $0

Supplies and Maintenance of equipment per week (>5 treatments per week)

Included Procedure $0 $0

BASE YEAR TOTAL COST ESTIMATE $241,930.00

LIN

No.

1BDescription of Service Estimated Qty.

6BUnit Unit Cost Total

Annual Cost

1001 90935-Hemodialysis procedure 310 Procedure $809.25 $250,867.50

1002 Cancellation after set-up (Labor and Supplies)

6 Procedure $181.56 $1,089.36

Treatment Cancellation Before Set-up

6 Procedure $103.75 $622.50

Waiting Time (after 15 minutes per hour)

12 Procedure $77.81 $933.72

Holiday differential- per procedure

10 Procedure $103.75 $1,037.50

1006 Blood Administration 24 Procedure $77.81 $1,867.44

1007 Extra Dialyzer 12 Procedure $15.56 $186.72

1008 Equipment Culture 48 Procedure $51.88 $2,490.24

Supplies and Maintenance of equipment per week (0-5 treatments per week)

Included Procedure $0 $0

Supplies and Maintenance of equipment per week (>5 treatments per week)

Included Procedure $0 $0

OPTION YEAR 1 TOTAL COST ESTIMATE $259,094.98

PERIOD OF PERFORMANCE – OPTION YEAR 2: October 1, 2027 to September 30, 2028

PERIOD OF PERFORMANCE – OPTION YEAR 3: October 1, 2028 to September 30, 2029

No.

2BDescription of Service Estimated Qty. 7BUnit Unit Cost

Total

Annual Cost

2001 90935-Hemodialysis procedure 325 Procedure $839.60 $272,870.00

Cancellation after set-up (Labor and Supplies)

6 Procedure $188.37 $1,130.22

Treatment Cancellation Before Set-up

6 Procedure $107.64 $645.84

2004 Waiting Time (after 15 minutes per hour)

12 Procedure $80.73 $968.76

Holiday differential- per procedure

10 Procedure $107.64 $1,076.40

2006 Blood Administration 24 Procedure $80.73 $1,937.52

2007 Extra Dialyzer 12 Procedure $16.15 $193.80

2008 Equipment Culture 48 Procedure $53.82 $2,583.36

Supplies and Maintenance of equipment per week (0-5 treatments per week)

Included Procedure $0 $0

Supplies and Maintenance of equipment per week (>5 treatments per week)

Included Procedure $0 $0

OPTION YEAR 2 TOTAL COST ESTIMATE

$281,405.90

No.

3BDescription of Service Estimated Qty. 8BUnit Unit Cost

Total

Annual Cost

3001 90935-Hemodialysis procedure 335 Procedure $871.08 $291,811.80

PERIOD OF PERFORMANCE – OPTION YEAR 4: October 1, 2029 to September 30, 2030

Cancellation after set-up (Labor and Supplies) 6 Procedure $195.44 $1,175.64

Treatment Cancellation Before Set-up 6 Procedure $111.68 $670.08

Waiting Time (after 15 minutes per hour) 12 Procedure $83.76 $1,005.12

Holiday differential- per procedure 10 Procedure $111.68 $1,116.80

3006 Blood Administration 24 Procedure $83.76 $2,010.24

3007 Extra Dialyzer 12 Procedure $16.75 $201.00

3008 Equipment Culture 48 Procedure $55.84 $2,680.32

Supplies and Maintenance of equipment per week (0-5 treatments per week)

Included Procedure $0 $0

Supplies and Maintenance of equipment per week (>5 treatments per week)

Included Procedure $0 $0

OPTION YEAR 3 TOTAL COST ESTIMATE $300,688.00

LIN

No. Description of Service 4BEstimate d Qty.

Unit 9BUnit Cost

Total

Annual Cost

4001 90935-Hemodialysis procedure 350 Procedure $903.75 $316,312.50

Cancellation after set-up (Labor and Supplies) 6 Procedure $202.76 $1,216.56

Treatment Cancellation Before Set-up 6 Procedure $115.87 $695.22

Waiting Time (after 15 minutes per hour) 12 Procedure $86.90 $1,042.80

Holiday differential- per procedure 10 Procedure $115.87 $1,158.70

TOTAL ESTIMATED COST FOR BASE YEAR AND ALL OPTION YEARS: $ 1,408,599.46

4006 Blood Administration 24 Procedure $86.90 $2,085.60

4007 Extra Dialyzer 12 Procedure $17.38 $208.56

4008 Equipment Culture 48 Procedure $57.93 $2,780.64

Supplies and Maintenance of equipment per week (0-5 treatments per week)

Included Procedure $0 $0

Supplies and Maintenance of equipment per week (>5 treatments per week)

Included Procedure $0 $0

OPTION YEAR 4 TOTAL COST ESTIMATE $325,500.58

B.3 PERFORMANCE WORK STATEMENT

1. GENERAL

1.1. Services Provided: The Contractor shall provide onsite Inpatient Acute Care Hemodialysis

Service to include two (2) Registered Nurses (RNs) and ancillary staff and equipment at the bedside of acutely ill patients for continuous on-call coverage 7 days per week, 24 hours per day.

Emergent services are within 4 hours; immediate services are within 4 hours and chronic routine hemodialysis treatments will be performed with 12 hours on site in accordance with the specifications contained herein to beneficiaries of the Department of Veterans Affairs (VA) at the Charles George VA Medical Center in Asheville, NC.

1.2. Place of Performance – Charles George VA Medical Center (CGVAMC), 1100 Tunnel Road, Asheville, NC 28805.

1.3. Authority: Under the authority of FAR Part 13.5, Simplified Acquisition Procedures.

1.4. Definitions/Acronyms- Terms used in this contract shall be interpreted as follows unless the context expressly requires a different construction and/or interpretation. In case of a conflict in language between the Definitions and other sections of this contract, the language in this section shall govern.

1.4.1. BLS: Basic Life Support

1.4.2. CDC/HICPAC: Center for Disease Control/Health Care Infection Control Practices Advisory Committee

1.4.3. CFR: Code of Federal Regulations

1.4.4. CO: Contracting Officer

1.4.5. COR: Contracting Officer's Representative

1.4.6. COS: Chief of Staff

1.4.7. CPARS: Contractor Performance Assessment Reporting System

1.4.8. EHR: Electronic Health Record – electronic health records system used by the VA

1.4.9. HIPAA: Health Insurance Portability and Accountability Act

1.4.10. HR: Human Resources

1.4.11. ISO: Information Security Officer

1.4.12. Medical Emergency – A sudden onset of a medical condition manifesting as acute symptoms of sufficient severity that the absence of immediate medical attention could reasonably result in permanently placing a patient’s health in jeopardy, causing other serious medical consequences, causing impairments to bodily functions, or causing serious or permanent dysfunction of any body organ or part.

1.4.13. MOD: Medical Officer of the Day

1.4.14. NPI: National Provider Identifier – A standard, unique 10-digit numeric identifier required by HIPAA. The Veterans Health Administration must use NPIs in all HIPAA- standard electronic transactions for individuals (health care practitioners) and organizational entities.

1.4.15. PPD - Purified Protein Derivative

1.4.16. PWS: Performance Work Statement

1.4.17. QA/QI: Quality Assurance/Quality Improvement

1.4.18. QM/PI: Quality Management/Performance Improvement

1.4.19. QASP: Quality Assurance Surveillance Plan

1.4.20. RN - Registered Nurse

1.4.21. TJC- The Joint Commission

1.4.22. TMS - Talent Management System

1.4.23. VAAR – Veterans Affairs Acquisition Regulations

1.4.24. VHA: Veterans Health Administration - The central office for administration of VA Medical Centers throughout the United States, located in Washington, D.C.

1.4.25. VETPRO- Veteran's Health Administration Credentialing System

1.4.26. VISN: Veterans Integrated Services Network – The regional oversight for VA Medical Centers.

1.4.27. VAMC: Veterans Affairs Medical Center – For purposes of this contract, this term shall mean the Charles George VA Medical Center (CGVAMC) in Asheville, NC.

2. QUALIFICATIONS:

2.1. Staff/Facility

2.1.1. License – Personnel assigned by the Contractor to perform the services covered by this contract shall be licensed as a Registered Nurse (RNs) in the state of North Carolina. The license must be active, current and unrestricted by the North Carolina Board of Nursing.

2.1.2. Credentialing and Privileging – VETPRO credentialing must be completed and verified before commencing work at the CGVAMC.

2.1.3. Technical Proficiency - Personnel assigned by the contractor must provide evidence of at least one full, active, current and unrestricted license, registration, certification, and/or other relevant credentials, for verification prior to assignment and throughout the certification process, as requested. Personnel and Contractor are responsible for keeping the VA appraised of anything that would adversely affect or otherwise limit their clinical privileges. Note: Failure to keep VA fully informed on these matters may result in administrative or disciplinary action.

2.1.4. Training (BLS and VA MANDATORY – Personnel performing these services shall be a licensed as a Registered Nurse (RN). All contract RNs will complete mandatory and yearly educational requirements at the Asheville VA Medical Center in the Talent Management System (TMS). All Contract RNs must have current yearly hemodialysis competencies and BLS certification on file.

Training Frequency (once a year, etc.) Annual Hours Active Threat Training Every 1 Year 1 Hour Government Ethics Every 1 Year 1 Hour Prevention of Workplace Harassment/No Fear Act

Every 1 Year 1 Hour

VA Core Values Training (ICARE Recommitment)

Every 1 Year 1 Hour

VA Privacy and Information Security Awareness and Rules of Behavior

Every 1 Year 1 Hour

Privacy and HIPAA Training Every 1 Year 1 Hour AHA BLS Every 2 Years 3 to 8 Hours Prevention/Management of Disruptive Behavior/Violence Prevention

Every 2 Years 8 Hours

Suicide Prevention: Suicide Risk Management Training for Clinicians

Every 1 Year 1 Hour

OPIOID Training Initial Onboarding 30 Minutes Service Connection Initial Onboarding 30 Minutes CBI Every 1 Year 1 Hour List other Training per local facility Courses to be assigned in TMS as required.

The Contractor shall provide to the COR a copy of the training certificates for each applicable employee within one (1) week of the initiation of the contract and annually thereafter, as required. Detailed instructions on account setup will be provided to the successful offeror upon contract award. Failure to complete this mandatory training listed above within the timeframe required shall be grounds for suspension or termination of all physical and/or electronic access privileges and removal from work on the contract until such time as the training is completed.

2.1.5. Standard Personnel Testing (PPD, etc.): Contractor shall provide initial evidence of health certification to include the following tests for RN(s) within five (5) calendar days after contract award and prior to the first duty shift to the COR. Tests shall be current within the past year initially and annually.

2.1.5.1.1. TUBERCULOSIS TESTING: Contractor shall provide proof of a negative Tuberculosis Skin Test (TST) or interferon-gamma release assays (IGRA) for all Contractors RN(s){This is applicable to all health care workers}. A negative chest radiographic report for active tuberculosis shall be provided in cases of positive TST or IGRA results. The TST or IGRA testing shall be repeated annually.

2.1.5.1.2. MEASLES, MUMPS, & RUBELLA TESTING: Contractors shall provide proof of immunity for all contractor personnel (This is applicable to all health care workers).

2.1.5.1.3. VARICELLA: Contractors shall provide proof of immunity for all Contractor Registered Nurse(s) {This is applicable to all health care workers}.

2.1.5.1.4. ACELLULAR PERTUSSIS: Contractors shall provide proof of 1 dose of Tdap vaccination for all Contractor Registered Nurse(s) {This is applicable to all health care workers}.

2.1.5.1.5. HEPATITIS B: Contractors shall provide proof of immunity for all Contractor

Nurses.

2.1.5.1.6. INFLUENZA: Contractors shall provide proof that all Contractor Registered Nurse(s) have received the annual Influenza vaccine unless it is contraindicated.

If the Contractor physician has a medical contraindication to the vaccine, they shall be required to wear a mask during the Influenza season. {This is applicable to all health care workers}.

2.1.5.1.7. OSHA REGULATION CONCERNING OCCUPATIONAL EXPOSURE TO

BLOODBORNE PATHOGENS: Contractor shall provide evidence of completing and passing generic self-study blood-borne pathogen training for all Contractor’s RN(s) {This is applicable to all health care workers}; provide their own Hepatitis B vaccination series and hepatitis B surface antigen test results following the hepatitis B vaccination series; maintain an exposure determination and control plan; maintain required records; and ensure that proper follow-up evaluation is provided following an exposure incident.

2.1.5.1.8. The CGVAMC shall notify the Contractor of any significant communicable disease exposures as appropriate. Contractor shall adhere to current CDC/HICPAC Guideline for Infection. Control in health care personnel (as published in American Journal for Infection Control- AJIC 1998; 26:289-354 http://www.cdc.gov/hicpac/pdf/InfectControl98.pdf) for disease control. Contractor shall provide follow up documentation of clearance to return to the workplace prior to their return.

2.1.5.1.9. Conflict of Interest - The Contractor and all contractor’s RNs are responsible for identifying and communicating to the CO and COR conflicts of interest at the time of Quotes and during the entirety of contract performance. At the time of Quotes, the Contractor shall provide a statement which describes, in a concise manner, all relevant facts concerning any past, present, or currently planned interest (financial, contractual, organizational, or otherwise) or actual or potential organizational conflicts of interest relating to the services to be provided. The Contractor shall also provide statements containing the same information for any identified consultants or subcontractors who shall provide services. The Contractor must also provide relevant facts that show how it’s organizational and/or management system or other actions would avoid or mitigate any actual or potential organizational conflicts of interest. These statements shall be in response to the VAAR provision 852.209-70 - Organizational Conflicts of interest (Oct 2020) and fully outlined in response to the subject attachment in Section D of the solicitation document.

2.1.6. Citizenship related Requirements:

2.1.6.1. The Contractor certifies that the Contractor shall comply with any and all legal provisions contained in the Immigration and Nationality Act of 1952, As Amended; its related laws and regulations that are enforced by Homeland Security, Immigration and Customs Enforcement and the U.S Department of Labor as these may relate to non-immigrant foreign nationals working under contract or subcontract for the Contractor while providing services to Department of Veterans Affairs patient referrals.

2.1.6.2. While performing services for the Department of Veterans Affairs, the Contractor shall not knowingly employ, contract or subcontract with an illegal alien; foreign national non-immigrant who is in violation their status, as a result of their failure to maintain or comply with the terms and conditions of their admission into the United States.

Additionally, the Contractor is required to comply with all “E-Verify” requirements consistent with “Executive Order 12989” and any related pertinent Amendments, as well as applicable Federal Acquisition Regulations.

2.1.6.3. If the Contractor fails to comply with any requirements outlined in the preceding paragraphs or its Agency regulations, the Department of Veterans Affairs may, at its discretion, require that the foreign national who failed to maintain their legal status in the United States or otherwise failed to comply with the requirements of the laws administered by Homeland Security, Immigration and Customs Enforcement and the U.S Department of Labor, shall be prohibited from working at the Contractor’s place of business that services VA patient referrals; or other place where the Contractor provides services to veterans who have been referred by the VA; and shall form the basis for termination of this contract for breach.

2.1.6.4. This certification concerns a matter within the jurisdiction of an agency of the United States and the making of a false, fictitious, or fraudulent certification may render the maker subject to prosecution under 18 U.S.C. 1001.

2.1.6.5. The Contractor agrees to obtain a similar certification from its subcontractors. The certification shall be made as part of the offeror’s response to the RFQ using the subject attachment in Section D of the solicitation document.

2.2. Annual Office of Inspector General (OIG) Statement: In accordance with HIPAA and the Balanced Budget Act (BBA) of 1977, the Department of Health and Human Services (HHS) Office of Inspector General (OIG) has established a list of parties and entities excluded from Federal health care programs. Specifically, the listed parties and entities may not receive Federal Health Care program payments due to fraud and/or abuse of the Medicare and Medicaid programs.

2.2.1. Therefore, Contractor shall review the HHS OIG List of Excluded Individuals/Entities on the HHS OIG web site at http://oig.hhs.gov/exclusions/index.asp to ensure that the proposed contractors RN(s) are not listed. Contractor should note that any excluded individual or entity that submits a claim for reimbursement to a Federal health care program, or causes such a claim to be submitted, may be subject to a Civil Monetary Penalty (CMP) for each item or service furnished during a period that the person was excluded and may also be subject to treble damages for the amount claimed for each item or service. CMP’s may also be imposed against the Contractor that employ or enter into contracts with excluded individuals to provide items or services to Federal program beneficiaries.

2.2.2. By submitting their Quotes, the Contractor certifies that the HHS OIG List of Excluded Individuals/Entities has been reviewed, and that the Contractor personnel and/or firm is not listed as of the date the offer/bid was signed.

2.3. Clinical/Professional Performance: The qualifications of Contractor personnel are subject to review by CGVAMC COS or his/her clinical designee and approval by the Medical Center Director as provided in VHA Handbook 1100.19. Clinical/Professional performance monitoring and review of all clinical personnel covered by this contract for quality purposes will be provided by the VAMC COS and/or the Chief of the Service or designee. A clinical COR may be appointed, however, only the CO is authorized to consider any contract modification request and/or make changes to the contract during the administration of the resultant contract.

2.4. Non-Personal Healthcare Services: The parties agree that the Contractor and all Contractor’s personnel shall not be considered VA employees for any purpose.

2.5. Indemnification: The Contractor shall be liable for, and shall indemnify and hold harmless the Government against, all actions or claims for loss of or damage to property or the injury or death of persons, arising out of or resulting from the fault, negligence, or act or omission of the Contractor, its agents, or employees.

2.6. Prohibition Against Self-Referral: Contractors RN(s) are prohibited from referring VA patients to contractor’s or their own practice(s).

2.7. Inherent Government Functions: Contractor and Contractors RN(s) shall not perform inherently governmental functions. This includes, but is not limited to, determination of agency policy, determination of Federal program priorities for budget requests, direction and control of government employees (outside a clinical context), selection or non-selection of individuals for Federal Government employment including the interviewing of individuals for employment, approval of position descriptions and performance standards for Federal employees, approving any contractual documents, approval of Federal licensing actions and inspections, and/or determination of budget policy, guidance, and strategy.

2.7.1. Technical Direction: Provide services under the direction of the Associate Director, Patient Care Services.

2.8. No Employee status: The Contractor shall be responsible for protecting Contractor’s RN(s) furnishing services. To carry out this responsibility, the Contractor shall provide or certify that the following is provided for all their staff providing services under the resultant contract:

2.8.1 Workers’ compensation

2.8.2 Professional liability insurance

2.8.3 Health examinations

2.8.4 Income tax withholding, and

2.8.5 Social security payments.

2.9. Tort Liability: The Federal Tort Claims Act does not cover Contractor or contractor RN(s).

When a Contractor or contractor’s RN(s) has been identified as a provider in a tort claim, the Contractor shall be responsible for notifying their legal counsel and/or insurance carrier. Any settlement or judgment arising from a Contractor’s (or contractor’s RN(s)) action or non-action shall be the responsibility of the Contractor and/or insurance carrier.

2.10. Key Personnel:

2.10.1. The minimum number of RNs to provide onsite Inpatient Acute Care Hemodialysis Services as defined in paragraph hours of operation in this section is two (2) and the ancillary equipment. The Contractor shall propose a minimum of five (5) Registered Nurses key personnel to be credentialed and be available for scheduling to meet the requirements of the contract.

2.10.2. Proposed personnel:

Name:______________________________

Name:______________________________

Name:______________________________

Name:______________________________

Name:______________________________

2.10.3. It is essential that the continuity of services is maintained to the maximum degree possible, substitution of contractor provided RNs shall be limited to urgent/emergent absences of approved, assigned providers. The Contractor shall be responsible for providing coverage to the VA during periods of vacancies of the Contractor’s personnel due to sick leave, personal leave, vacations and additional coverage as required.

In the event a scheduled RN is unable to begin or complete an assigned shift, the contractor shall provide replacement nursing coverage within 2 hours and notify the COR at the (CGVAMC) immediately of the schedule change.

2.10.4 Personnel Substitutions: For temporary substitutions where the key person shall not be reporting to work for three (3) consecutive workdays or more, the Contractor shall provide a qualified replacement for the key person. The substitute shall have comparable qualifications to the key person. Any period exceeding two weeks will require the procedure as stated above.

2.10.5. The Government reserves the right to refuse acceptance of any Contractor personnel at any time after performance begins, if personal or professional conduct jeopardizes patient care or interferes with the regular and ordinary operation of the facility.

Breaches of conduct include intoxication or debilitation resulting from drug use, theft, patient abuse, dereliction or negligence in performing directed tasks, or other conduct resulting in formal complaints by patients or other staff members to designated Government representatives. Standards for conduct shall mirror those prescribed by current federal personnel regulations. Should the VA COS or designee show documented clinical problems or continual unprofessional behavior/actions with any Contractors RN (s), s/he may request, without cause, immediate replacement of said Contractors RN (s). The CO and COR shall deal with issues raised concerning Contractor’s RN(s) conduct. The final arbiter on questions of acceptability is the CO.

2.10.6. Contingency Plan: Because continuity of care is an essential part of CGVAMC’s medical services, The Contractor shall have a contingency plan in place to be utilized if Contractors RN(s) leave Contractor’s employment or is unable to continue performance in accordance with the terms and conditions of the resulting contract.

3. VA HOURS OF OPERATION / SCHEDULING

3.1. VA Business Hours: Seven (7) days per week, twenty-four (24) hours per day on call:

3.1.1. Work Schedule: Seven (7) days per week, twenty-four (24) hours per day on call. The CGVAMC will only pay for qualified services received by inpatients requiring Hemodialysis. Pay will be per procedure.

3.1.2. Federal Holidays: The following holidays are observed by the Department of Veterans Affairs:

• New Year’s Day

• Martin Luther King’s Day

• President’s Day

• Memorial Day

• Juneteenth

• Independence Day

• Labor Day

• Columbus Day

• Veterans Day

• Thanksgiving

• Christmas

• Any day specifically declared to be a national holiday.

4. CONTRACTOR RESPONSIBILITIES

4.1. SERVICES REQUIRED: The Contractor RN(s) and ancillary staff shall have demonstrated clinical training and competence to perform assigned duties, and the ancillary equipment as listed:

4.1.1. The Contractor’s staff shall be responsible for provision of the ordered services to include set-up and safety check of equipment and water treatment system.

4.1.2. The contract staff shall notify the Nurse Manager & Charge Nurse of their arrival and departure from the location of the procedure.

4.1.3. Initiating treatment, monitoring of treatment and termination of treatment.

4.1.4. Documentation of treatment on CGVAMC approved forms.

4.1.5. Clean-up of dialysis equipment and proper storage of machines and supplies.

4.1.6. Contract RN’s will be available to provide continuing education and training to assure current technical and clinical knowledge of the CGVAMC staff.

4.1.7. Contractor staff shall provide education to patients and families as needed regarding hemodialysis procedures.

4.1.8. Contractor shall report quarterly on established clinical indicators for all CGVAMC patients who received hemodialysis treatments. Clinical Indicators include vascular access site, dialysis prescriptions, patient assessments, patient education and communication and safety.

4.1.9. Contractor shall maintain records of the equipment culture results and supply copies to the CGVAMC monthly and Association for the Advancement of Medical Instrumentation (AAMI) or equivalent testing for chemical contaminants annually.

4.1.10. Contractor shall supply a quarterly infection control summary to the Asheville VAMC.

4.1.11. Contractor shall supply a quarterly infection control summary to the CGVAMC.

4.1.12. Contractor shall report any culture or endotoxin result above the actionable threshold to the

Dialysis Program Manager within 24 hours of result reception.

4.1.13. Contractor shall remove from service any machine with results above the unacceptable threshold until results are in the acceptable range and the Dialysis Program Manager will be informed of all related actions.

4.1.14. Contractor shall supply preventative maintenance records in accordance with TJC requirements. Copies of preventative maintenance records shall be stored in the room where the Dialysis and Reverse Osmosis machines are stored.

4.1.15. Contractor shall supply: commercially available dialysis solutions, tubing sets for provider equipment, dialyzers, all filters required for contractor equipment, fistula needles and water quality analysis supplies.

4.2. Standards of Practice and Care: The contractors shall be responsible for meeting or exceeding VA standards in providing RN(s) in providing Inpatient Acute Care Hemodialysis services and the standards of care shall be of a quality, meeting or exceedingly currently recognized national standards as established by:

4.2.1. The professional standards of Joint Commission (JC)

https://www.jointcommissioninternational.org/-/media/jci/jci-documents/accreditation/ambulatory/jci_dialysis_pages.pdf.

4.2.2. The standards of the American Hospital Association (AHA) http://www.hpoe.org/resources?show=100&type=8 and;

4.2.3. The requirements are contained in this PWS.

4.3. MEDICAL RECORDS

4.3.1. Authorities: Contractor’s physician(s) providing healthcare services to VA patients shall be considered as part of the Department Healthcare Activity and shall comply with the 5 U.S.C.552a (Privacy Act), 38 U.S.C. 5701 (Confidentiality of claimants records), 5 U.S.C.

552 (FOIA), 38 U.S.C. 5705 (Confidentiality of Medical Quality Assurance Records) 38 U.S.C. 7332 (Confidentiality of certain medical records), Title 5 U.S.C. § 522a (Records Maintained on Individuals) as well as 45 C.F.R. Parts 160, 162, and 164 (HIPAA).

4.3.2. HIPAA: This contract and its requirements meet exception in 45 CFR 164.502(e), and do not require a BAA in order for Covered Entity to disclose Protected Health Information to:

a health care provider for treatment of VA patients. Based on this exception, a BAA is not required for this contract. Health records generated by this contract or provided to the Contractors by the VA are covered by the VA Privacy Act system of records entitled ‘Patient Medical Records-VA’ (24VA10A7). Contractor generated VA Patient records are the property of the VA and shall not be accessed, released, transferred, or destroyed except in accordance with applicable laws and regulations. Contractor shall ensure that all records pertaining to medical care and services provided to VA patients are captured in the VA electronic health record system as required by VA policy as discussed in 4.3.4.

4.3.3. Disclosure: Contractor’s RN(s) may may have access to patient medical records for the purpose of providing medical care and services to VA patients and performing services under the contract; however, Contractor shall obtain permission from the VA before disclosing any patient information outside VA. VA authorizes the Contractor to discuss patient health information for coordination of care with community health care providers in compliance with VA regulations, HIPAA and VHA Directive 1605.01, Privacy and Release of Information. The VA will provide the Contractor with a copy of VHA Directive 1907.01, Health Information Management and Health Records and VHA Directive 1605.1, Privacy and Release of Information. The penalties and liabilities for the unauthorized disclosure of VA patient information mandated by the statutes and regulations mentioned above, apply to the Contractor.

4.3.4. Professional Standards for Documenting Care: Care shall be appropriately documented in medical records in accordance with standard commercial practice and guidelines established by VHA Directive 1907.01 Health Information Management and Health Records and all guidelines provided by the facility.

4.3.5. Release of Information: The VA shall maintain control of releasing any copies of patient health information or health records and will follow policies and standards as defined but not limited to Privacy Act requirements. Contractor will not release or disclose copies of records and will refer to all such requests to the Release of Information Department at the VA facility that were assigned.

4.4 DIRECT PATIENT CARE: 100% of the time involved in direct patient care.

4.4.1. Contractor shall be responsible for each of the following areas stated in the PWS and the section below:

4.4.2. Patient Safety: Patient safety incidents must be reported immediately (maximum within 24 hours) using the Patient Safety Report at the CGVAMC.

4.4.3. Provide Hemodialysis treatments.

4.4.4. Properly evaluate patient prior to, during and after the Hemodialysis treatment.

4.5 ADMINISTRATIVE: 0% of the time not involved in direct patient care.

4.5.1. The Contractor will not be responsible for administrative tasks.

4.6 PERFORMANCE STANDARDS, QUALITY ASSURANCE AND QUALITY

IMPROVEMENT

4.6.1 Methods of Surveillance: Random Inspections, Direct Observation, Periodic Sampling or Random Sampling.

4.6.2. Performance Standards: The Quality Assurance Surveillance Plan (QASP) outlines required standards and will be a part of the resultant contract.

4.6.3. Required Registration with Contractor Performance Assessment Reporting System (CPARS)

4.7 GOVERNMENT RESPONSIBILITY

4.7.1. Oversight of Service / Performance Monitoring / Contract Administration

4.7.2. VA Support Personnel, Services or Equipment

4.8. PERFORMANCE STANDARDS, QUALITY ASSURANCE (QA) AND QUALITY

IMPROVEMENT(QI)

4.8.1. Quality Management/Quality Assurance Surveillance: Contract personnel shall be subject to Quality Management measures, such as patient satisfaction surveys, timely completion of medical records. Methods of Surveillance: Focused Provider Practice Evaluation (FPPE) and Ongoing Provider Practice Evaluation (OPPE). Contractor performance will be monitored by the government using the standards as outlined in this Performance Work Statement (PWS) and methods of surveillance detailed in the Quality Assurance Surveillance Plan (QASP). The QASP shall be attached to the resultant contract and shall define the methods and frequency of surveillance conducted.

4.8.2. Patient Complaints: The CO will resolve complaints concerning Contractor relations with the Government employees or patients. The CO is the final authority on validating complaints. In the event that The Contractor is involved and named in a validated patient complaint, the Government reserves the right to refuse acceptance of the services of such personnel. This does not preclude refusal in the event of incidents involving physical or verbal abuse.

4.8.3. The Government reserves the right to refuse acceptance of any Contractor personnel at any time after performance begins, if personal or professional conduct jeopardizes patient care or interferes with the regular and ordinary operation of the facility. Breaches of conduct include intoxication or debilitation resulting from drug use, theft, patient abuse, dereliction or negligence in performing directed tasks, or other conduct resulting in formal complaints by patients or other staff members to designated Government representatives. Standards for conduct shall mirror those prescribed by current federal personnel regulations. The CO and COR shall deal with issues raised concerning Contractor’s conduct. The final arbiter on questions of acceptability is the CO.

4.8.4. Performance Standards:

4.8.4.1. Measure: Registered Nurse Quality Performance

Performance Requirement: All Contractor’s RN(s) shall perform in accordance with clinical standards.

Standard: 100% of care provided within clinical standards of care.

Acceptable Quality Level: 100% meet standards.

Surveillance Method: Ongoing Provider Performance Evaluation (OPPE) data pertinent to care performed for each provider working under this contract. OPPE data will review the following elements:

Frequency: Quarterly A. Patient Care Performance B. Medical/Clinical knowledge C. Practiced Based Learning and Improvement D. Interpersonal and Communication Skills E. Professionalism F. System Based Practice

4.8.4.2. Measure: Qualifications of Key Personnel

Performance Requirement: All Contractor’s RNs shall be certified in providing Hemodialysis Services.

Standard: All (100%) nurses provided by Contractor are RNs certified and experienced in providing Hemodialysis Services.

Acceptable Quality Level: 100%.

Surveillance Method: Random Inspection of qualification documents.

Frequency: Quarterly

4.8.4.3. Measure: Scope of Practice/Privileging

Performance Requirement: Contractor’s RNs perform within their individual scopes of practice/privileging.

Standard: All (100%) Contractor’s RNs perform within their scope of practice/privileges 100% of the time.

Acceptable Quality Level: 100%.

Surveillance Method: Random Inspection of records.

Frequency: Quarterly

4.8.4.4. Measure: Patient Access

Performance Requirement: The Contractor shall provide Contractor’s RN(s) in accordance with the operating hours and VA clinical schedule outlined in this

PWS.

Standard: All (100%) Contractor’s RNs are on time and available to perform services.

Acceptable Quality Level: Contractor’s RNs are on-time and available to perform services 100% of the time.

Surveillance Method: Periodic Sampling of Time and Attendance Sheets Frequency: Quarterly

4.8.4.5. Measure: Patient Safety

Performance Requirement: Patient safety incidents shall be reported using Patient Safety Report. All incidents reported immediately (within 24 hours.)

Standard: All (100%) of patient safety incidents are reported using Patient Safety Report within 24 hours of incident.

Acceptable Quality Level: 100% of patient safety incidents are reported using Patient Safety Report within 24 hours of incident.

Surveillance Method: Random Inspection of Incident Forms.

4.8.4.6. Measure: Maintains licensing, registration, and certification Performance Requirement: Updated Licensing, registration and certification shall be provided as they are renewed. Licensing and registration information kept current.

Standard: All (100%) licensing, registration(s) and certification(s) for Contractor’s RNs shall be provided as they are renewed. Licensing and registration information kept current.

Acceptable Quality Level: 100%

Surveillance Method: Periodic Sampling

4.8.4.7. Measure: Mandatory Training

Performance Requirement: Contractor shall complete all required training on time per CGVAMC policy

Standard: All (100%) of required training is completed on time by Contractor’s RNs

Acceptable Quality Level: 100% completions.

Surveillance Method: Periodic Inspection, verification of training via TMS reports.

Frequency: Quarterly

4.8.4.8. Measure: Privacy, Confidentiality and HIPAA

Performance Requirement: Contractor is aware of all laws, regulations, policies and procedures relating to privacy, confidentiality and HIPAA and complies with all standards of zero breaches of privacy or confidentiality.

Standard: All (100%) Contractor’s RN(s) comply with all laws, regulations, policies and procedures relating to privacy, confidentiality and HIPAA.

Acceptable Quality Level: 100% compliance; no deviations.

Surveillance Method: Periodic Sampling; Contractor shall provide evidence of annual training required by CGVAMC, reports violations per VA Directive 6500.6.

Frequency: Quarterly

4.8.4.9. Measure: Professionalism/Conduct

Performance Requirement: Contractor RNs will ensure patients are satisfied with the care given.

Standard: Patient satisfaction will be monitored by Nurse Manger in SICU for Hemodialysis patients who document a complaint with Patient Advocate or other approved source.

Acceptable Quality Level: No more than one (1) verifiable complaint per quarter.

Surveillance Method: Periodic Inspection of Patient satisfaction via the Press-Ganney System

4.8.4.10. Measure: Hand-washing Surveillance- Personal Protective Equipment Usage

Performance Requirement: Handwashing and PPE usage will be monitored for hemodialysis RNs in the SICU Standard: Appropriate handwashing skills and PPE will be utilized by the dialysis RNs while caring for the hemodialysis patient Acceptable Quality Level: 90%

Surveillance Method: Direct Observation

4.8.4.11 Measure: Current Yearly Dialysis Competencies

Performance Requirement: Hemodialysis competencies will be current on a yearly basis Standard: All contract RNs must have current yearly hemodialysis competencies Acceptable Quality Level: 100% Surveillance Method: Contractor will provide COR with a copy of annual hemodialysis competencies, a copy will be filed in individual…