ESBD_357368_1714399651240_RFP 1914-JW Mgmt & Op Services for Amarillo TSVH - FINAL 4-29-24.pdf

Texas General Land Office and Veterans Land Board -i- RFP No. 1914-JW

TEXAS GENERAL LAND OFFICE

AND

VETERANS LAND BOARD

is

REQUESTING COMPETITIVE SEALED PROPOSALS

for Management and Operation Services at the Ussery-Roan Texas State Veterans Home in Amarillo, Texas

REQUEST FOR PROPOSALS NO. 1914-JWClass 948 / Item 65; Class 958 / Items 56, 58

Release Date: April 29, 2024

Deadline for Submission: June 3, 2024 at 2:00 p.m. CDT

Solicitation Point of Contact: Jaynee Williams, CTPM, CTCM Jaynee.Williams@GLO.Texas.Gov

You are responsible for checking the Electronic State Business Daily (ESBD) website, http://www.txsmartbuy.com/esbd, for any addenda to this Solicitation. Please search under Agency Code 305 (General Land Office and Veterans Land Board). The Respondent’s failure to periodically check the ESBD will in no way release that Respondent from addenda or additional information resulting in additional requirements of the Solicitation.

mailto:Jaynee.Williams@GLO.Texas.Gov http://www.txsmartbuy.com/esbd

Texas General Land Office and Veterans Land Board -ii- RFP No. 1914-JW

Table of Contents

ARTICLE I. EXECUTIVE SUMMARY, DEFINITIONS, AND AUTHORITY

1.1. Executive Summary

1.1.1 Regulatory Framework

1.1.2 Funding

1.1.3 Inspection

1.2. Definitions

1.3. Authority

ARTICLE II. SCOPE OF WORK

2.1. Scope of Services Requested

2.2. Specific Requirements – Management

2.2.1 Information Systems and Medical Records

2.2.2 Resident Trust Fund Accounts and Other Accounts

2.2.3 Financial Controls

2.2.4 Risk Management and Loss Prevention

2.2.5 Resident Rights

2.2.6 Disposition of Remains

2.2.7 Transfer Agreements

2.2.8 Infection Control

2.2.9 Peer Review Committee and Quality Assurance and Performance Improvement ... 9

2.3. Specific Requirements – Operations

2.3.1 Policies, Procedures, and Implementation

2.3.2 Medical Care and Required Services

2.3.3 Accounting

2.3.4 Billing Payor Sources During Contract Term

2.3.5 Collections

2.3.6 Census and Financial Data

2.3.7 Admissions

2.3.8 Purchasing

2.3.9 Reports

2.3.10 Utilities

2.3.11 On-Site Representative (OSR)

2.3.12 Monitoring

2.3.13 Volunteer Programs

2.3.14 Community Development and Transportation

2.3.15 Janitorial and Laundry Services

2.4. Specific Requirements – Personnel and Staffing

Texas General Land Office and Veterans Land Board -iii- RFP No. 1914-JW

2.4.1 Personnel

2.4.2 Required Staffing

2.4.3 Orientation and Training

2.4.4 GLO/VLB Participation

2.4.5 Non-Competition Clause

2.4.6 Continued Operations

2.4.7 Licensing and Credentials

2.4.8 Staffing Development Plan

2.5. Specific Requirements – Maintenance, Repairs, and Housekeeping

2.5.1 Maintenance and Repairs

2.5.2 Warranty Repairs

2.5.3 Scheduled Maintenance and Records

2.5.4 Maintenance Inspections

2.5.5 Communication with GLO/VLB

2.5.6 Maintenance Staff

2.6. Specific Requirements – Nutrition and Dining Program

2.7. Contract Term

2.8 Collusion

ARTICLE III. ADMINISTRATIVE INFORMATION

3.1. Schedule of Events

3.2. Inquiries

3.2.1 Contact

3.2.2 Clarifications

3.2.3 Responses

3.2.4 Prohibited Communications

3.2.5 Site Visit

3.2.6 Pre-Proposal Conference - OPTIONAL

3.3. Solicitation Response Composition

3.3.1 General Requirements

3.3.2 Solicitation Response Format

3.3.3 Page Limit and Supporting Documentation

3.4. Solicitation Response Submission and Delivery

3.4.1 Deadline

3.4.2 Labeling

3.4.3 Delivery

3.4.4 Alterations, Modifications, and Withdrawals

ARTICLE IV. SOLICITATION RESPONSE EVALUATION & AWARD PROCESS.. 28

4.1. Evaluation Criteria

Texas General Land Office and Veterans Land Board -iv- RFP No. 1914-JW

4.1.1 Conformance with State Law

4.1.2 Minimum Qualifications

4.1.3 Selection Criteria

4.1.4 Detailed Scoring Methodology

4.2. Oral Presentation

4.3. Best and Final Offer (BAFO)

4.4. Contract Award

ARTICLE V. REQUIRED RESPONDENT INFORMATION

5.1. Respondent Information

5.1.1 Company Narrative

5.1.2 Company Profile

5.1.3 Operations and Management Experience

5.1.4 Key Staffing Profile

5.2. Technical Proposal / Operational Plan

5.3. References

5.4. Major Subcontractor Information

5.5. Litigation and Regulatory History

5.6. Historically Underutilized Business (HUB)

5.7. Conflicts

5.8. Financial Capability

ARTICLE VI. COST PROPOSAL

6.1. Cost Proposal – General Information

6.2. Specific Cost Information

6.2.1 Fee Arrangements

6.2.2 Budget Estimates

6.3. Profile Information

6.3.1 Occupancy Rate

6.3.2 Resident Mix

ARTICLE VII. TERMS AND CONDITIONS

7.1. General Conditions

7.1.1 Amendment

7.1.2 Informalities

7.1.3 Rejection

7.1.4 Irregularities

7.1.5 Offer Period

7.1.6 Open Records

7.1.7 Contract Responsibility

7.1.8 Public Disclosure

7.1.9 Remedies

Texas General Land Office and Veterans Land Board -v- RFP No. 1914-JW

7.2. Insurance

7.2.1 Required Coverages

7.2.2 Alternative Insurability

7.3. Protest

7.4. Contract Terms and Solicitation Acceptance

7.4.1 Terms and Conditions

7.4.2 Affirmations and Solicitation Acceptance

7.5. Vendor Performance Reporting

7.6. Certificate of Interested Parties

ARTICLE VIII. SUBMISSION CHECKLIST

EXHIBIT A. AFFIRMATIONS AND SOLICITATION ACCEPTANCE ...................... A-1

EXHIBIT B. SAMPLE CONTRACT .................................................................................. B-1 EXHIBIT C. HUB SUBCONTRACTING PLAN ............................................................... C-1 EXHIBIT D. HUB SUBCONTRACTING PLAN PRESENTATION .............................. D-1 EXHIBIT E. AMARILLO TSVH 2023 CENSUS ............................................................... E-1

Texas General Land Office and Veterans Land Board -1- RFP No. 1914-JW

ARTICLE I. EXECUTIVE SUMMARY, DEFINITIONS, AND AUTHORITY

1.1. EXECUTIVE SUMMARY

The Texas General Land Office (“GLO”) and the Veterans Land Board (“VLB”) (collectively the “GLO/VLB”) is seeking proposals from entities to manage and operate the Ussery-Roan Texas State Veterans Home located in Amarillo, Texas. ML Cares, LLC currently operates the Ussery-Roan Texas State Veterans Home (the “Home”).

The GLO/VLB currently owns nine Texas State Veterans Homes across the state of Texas.

These facilities provide skilled nursing care for the benefit of eligible veterans of the United States Armed Forces.1 Each facility is a single-story structure with capacities ranging from 100 to 160 residents, featuring spacious rooms, dining facilities, activity areas, covered porches, courtyards and landscaped grounds, on-site occupational and physical therapy clinics, and a certified Alzheimer’s Care Unit. The Ussery-Roan Texas State Veterans Home in Amarillo, Texas opened in 2007 and has 120 total resident beds, including 30 beds designated for Alzheimer’s and related dementia.

The GLO/VLB will consider proposals from entities that demonstrate the ability to operate and manage the facility on behalf of the GLO/VLB, in accordance with applicable federal, state, and local laws and regulations and in accordance with the terms and conditions outlined in the Sample Management and Operations Agreement (“Sample Contract”) attached hereto as Exhibit B, Sample Contract. Respondents must execute Exhibit A, Affirmations and Solicitation Acceptance, and complete other items listed on the Submission Checklist in Article VIII to be considered. Additional information on the GLO/VLB and its programs can be found at http://vlb.texas.gov.

1.1.1 Regulatory Framework

The Operator shall be subject to applicable federal, state, and local laws and regulations. To be recognized by the VA as a Veterans Home and to receive per diem payment from the VA, each Veterans Home must meet certain standards and

1 To be eligible for admission into a Texas State Veterans Home applicants must be recognized as an “eligible veteran” by the United States Veterans Administration (VA) and:

• Require long-term nursing care as determined by a physician and concurred by the VA,

• Be at least 18 years of age,

• Be a bona fide resident of Texas, or a veteran applicant willing to be a resident of Texas, at the time of application for admission,

• Have been a legal resident of Texas at the time of entry into military service, have resided in Texas continuously for at least one year immediately prior to application for admission, or reside in an out-of-state nursing home and are transferring to a Texas State Veterans Home (residence based solely on military assignment is excluded), and

• Not have been dishonorably discharged. Additionally, eligibility for admission is extended to persons over the age of 18 years of age who have been bona fide residents of Texas continuously for at least one year immediately prior to application for admission, and who are one of the following:

• The spouse or unmarried surviving spouse of a veteran, or

• Gold Star parents, all of whose children died while serving in the United States Armed Forces.

http://vlb.texas.gov/

Texas General Land Office and Veterans Land Board -2- RFP No. 1914-JW provide certain services prescribed by the Secretary of the VA for community nursing homes. These standards are similar to those used for the certification of nursing facilities for Medicare and Medicaid programs.2 Additionally, each Veterans Home must be licensed as a nursing facility in the state of Texas in accordance with Chapter 242 of the Texas Health and Safety Code and the corresponding regulations set forth in Title 26, Part 1, Chapter 554 of the Texas Administrative Code. The VA regulations and services required to be provided by the selected Respondent may be found in Title 38 C.F.R. Parts 17 and 51, et seq.

Notwithstanding the foregoing, Operator is solely responsible for determining and complying with all federal, state, and local laws, regulations, rules, and ordinances that apply to the operation of the Home.

1.1.2 Funding

The VA provides a per diem subsidy for care to eligible veterans as set forth in 38 C.F.R. § 51.50. The per diem is currently $138.29 per day. The GLO/VLB has established daily rates for the cost of care for each Veterans Home; the Operator shall bill and collect from each resident. The private room rate is currently $202.80 per day, the semi-private room rate is currently $149.80, the memory care private room rate is currently $216.80, and the memory care semi-private room rate is currently $163.80 per day at the Home. Additional rates and room type information may be found at:

https://vlb.texas.gov/veterans-homes/costs/index.html

1.1.3 Inspection

Pursuant to applicable regulations and to maintain certification, the Home is subject to ongoing inspections and surveys by the VA, the GLO/VLB, and HHSC throughout the contract period, at the discretion of those entities. Surveys and inspections are conducted to ensure that each Veterans Home is being operated in compliance with all applicable standards and regulations. Additionally, an On-Site Representative (OSR), an employee of the GLO/VLB, is stationed on a full-time basis in the Home to ensure contractual compliance and that proper services are provided to the residents.

1.2. DEFINITIONS

“Addendum” means a written clarification or revision to the Request for Proposals issued by the GLO/VLB. Respondents must acknowledge receipt of any addenda in the submission of the Solicitation Response.

2 42 CFR § 483, relating to Medicare and Medicaid.

http://www.statutes.legis.state.tx.us/Docs/HS/htm/HS.242.htm https://texreg.sos.state.tx.us/public/readtac$ext.ViewTAC?tac_view=4&ti=26&pt=1&ch=554 https://texreg.sos.state.tx.us/public/readtac$ext.ViewTAC?tac_view=4&ti=26&pt=1&ch=554 https://www.benefits.va.gov/WARMS/booki.asp#b https://vlb.texas.gov/veterans-homes/costs/index.html

Texas General Land Office and Veterans Land Board -3- RFP No. 1914-JW

“Adverse Events” means untoward incidents, therapeutic misadventures, iatrogenic injuries, or other adverse occurrences directly associated with care or services provided within the jurisdiction of a State Veterans Home.

“Affiliate” means any individual or entity that, directly or indirectly, is in control of, is controlled by, or is under common control with, Respondent. Respondent shall be deemed to control another entity if either possesses, directly or indirectly, the power to direct or cause the direction of the management and policies of the other entity, whether through the ownership of voting securities, membership interests, by contract, or otherwise.

“Capital Equipment” means Equipment, the cost of which for a single unit equals or exceeds $2,500.00 before taxes, if applicable.

“Capital Improvement” means (i) any Improvement, the cost of which is equal to or exceeds $2,500.00 before taxes, if applicable, and/or (ii) any Improvement, the cost of which for a single addition or alteration is less than $2,500.00, and is required by a Regulatory Agency in multiples, the aggregate cost of which exceeds $2,500.00, before taxes, if applicable.

“C.F.R.” means Code of Federal Regulations.

“CMS” means Centers for Medicare and Medicaid Services.

“Consumables” means goods such as medical supplies and other items including, without limitation, food, non-prescription medications, dressings, printed forms, soap, and disposable diapers, which are routinely used and replenished as required to operate the Veterans Home.

“Director of Nursing” means a registered nurse who supervises the care of all patients at the Home.

“Equipment” means all items necessary for the functioning of all services of the Veterans Home, including information technology equipment required for accounting and record keeping, and items necessary for the maintenance of buildings and grounds. “Equipment” does not include Consumables.

“ESBD” means the Electronic State Business Daily, available at http://www.txsmartbuy.com/esbd.

“GAAP” means Generally Accepted Accounting Principles.

“GLO” means the Texas General Land Office. Employees of the VLB are considered employees of the GLO.

“HHSC” means the Texas Health and Human Services Commission, successor agency to the Texas Department of Aging and Disability Services or “DADS.”

Texas General Land Office and Veterans Land Board -4- RFP No. 1914-JW

“HIPAA” means the Health Insurance Portability and Accountability Act of 1996 and associated regulations located in 45 C.F.R Parts 160 and 164.

“Home” means the Ussery-Roan Texas State Veterans Home located at 200 Veterans Drive, Amarillo, Texas 78114.

“HUB” means Historically Underutilized Business as defined by Chapter 2161 of the Texas Government Code.

“HUB Subcontracting Plan” or “HSP” means the form required by Texas Government Code § 2161.252 and 34 TAC § 20.285 for each contract with an expected value of $100,000 or more, in which Respondents must demonstrate a good faith effort to subcontract with HUBs. The HSP is posted to the ESBD as a separate file accompanying this Solicitation and must be included with the Solicitation Response.

“Improvement” means any addition or alteration of the buildings or grounds of the Veterans Home.

“Individualized Care Plan (ICP)” means a plan reflecting a Resident’s unique conditions, abilities, needs, routines, preferences, and goals.

“Key Staff” means experienced, professional and/or technical personnel who will have major responsibilities under the contract and/or provide unusual or unique expertise essential for successful completion of the work performed.

“On-Site Representative” or “OSR” means the designated GLO/VLB employee who maintains an office in the Veterans Home to oversee the operations of the Veterans Home on the GLO/VLB’s behalf.

“Operator” means the entity contracted to manage, operate, and provide all necessary services for the Ussery-Roan Texas State Veterans Home, pursuant to this RFP.

“PIA” means the Public Information Act, Chapter 552 of the Texas Government Code.

“Regulatory Agency/Agencies” means the Center for Medicare and Medicaid Services (“CMS”), the United States Department of Health and Human Services (“HHS”), the Texas Health and Human Services Commission (“HHSC”), the United States Department of Veterans Affairs (“VA”), and any other applicable governmental agency.

“Resident” means a person who meets the eligibility requirements and is admitted to a Texas State Veterans Home to receive skilled nursing care.

“Resident Benefit Donation Account” means an account established to receive and expend donations at each individual TSVH.

Texas General Land Office and Veterans Land Board -5- RFP No. 1914-JW

“Resident Council” means the collective group of Residents elected by the entire Resident population to represent the Residents in the scheduling of activities, acceptance of goods or funds, and purchase of items for use by the Resident population.

“Respondent” means the entity responding to this Solicitation.

“Responsible Party” means a person other than the resident who agrees in writing to be financially responsible for all unpaid balances owing as a result of the care provided in a Veterans Home by an Operator.

“RFP” means Request for Proposals.

“Service-Connected Disability” or “SCD” means a disability as defined under 38 U.S.C. § 101(16).

“Solicitation” means this RFP.

“Solicitation Response” means the Respondent’s entire response to this Solicitation, including all documents requested in Articles III and V.

“State” means the state of Texas and any state agency; the GLO/VLB or state agency identified in this Solicitation, its officers, employees, or authorized agents.

“TAC” means the Texas Administrative Code.

“TELS” means the web-based facility management software application (https://tels.directsupply.com) used in Texas State Veterans Homes.

“USDVA” or “VA” means the United States Department of Veterans Affairs.

“Veterans Home” means any Texas State Veterans Home. “Home” specifically refers to the Ussery-Roan Texas State Veterans Home located in Amarillo, Texas.

“VLB” means the Veterans Land Board.

1.3. AUTHORITY

The GLO/VLB is soliciting the service listed herein under Chapters 2155-2156 of the Texas Government Code and Chapter 164 of the Texas Natural Resources Code.

REMAINDER OF PAGE INTENTIONALLY LEFT BLANK

https://tels.directsupply.com/

Texas General Land Office and Veterans Land Board -6- RFP No. 1914-JW

ARTICLE II. SCOPE OF WORK

2.1. SCOPE OF SERVICES REQUESTED

Respondent must demonstrate the ability to perform the services described in this Solicitation and specifically enumerated under this Section in its Solicitation Response.

Operator must provide these services for the Home to be formally recognized by the VA and the state of Texas as a skilled nursing facility. In addition to these requirements, the selected Operator shall be bound to specific terms and conditions in the General Affirmations and Solicitation Acceptance in Exhibit A. These terms and conditions are similar to those found in the GLO/VLB’s Sample Contract, attached hereto and incorporated herein by reference for all purposes as Exhibit B. The terms and conditions in Exhibit B are subject to change prior to the execution of any contract that may result from this Solicitation.

Operator shall manage and operate the Home in compliance with all applicable laws, rules, regulations, standards, and policies of federal, state, and local governments and any other entity that may have jurisdiction. Operator shall supervise the performance of all administrative functions necessary to manage and operate the Home including comprehensive medical, nursing, administrative, and social programs. Operator shall manage and operate the Home in a manner that respects the rights and dignity of each resident, ensuring that all veterans and non-veteran residents have the opportunity to achieve a maximum level of independent functioning and the best possible quality of life.

Moreover, Operator shall not place in jeopardy any licenses or certifications legally required to operate the Home as a certified Medicare and Medicaid nursing facility with an Alzheimer’s Care Unit. Operator shall provide the GLO/VLB, through its On-Site Representative, any reasonable operational information that may be specifically requested by the GLO/VLB, including any information needed to assist the GLO/VLB in complying with any reporting or other obligations imposed on the GLO/VLB by any federal, state, or local agency. Operator shall provide the OSR with information and complete access to the Home and to the residents, reports, meetings, etc. at any time. Operator shall immediately notify the GLO/VLB and other entities, as may be required by law, of any abuse or suspected abuse of a resident, any unexpected or unexplained injury or death of a resident, any allegations or incidents of neglect or exploitation, or any immediate threat to the health or safety of any resident.

2.2. SPECIFIC REQUIREMENTS – MANAGEMENT

In consultation with, for and on behalf of, and in the name of the GLO/VLB, Operator shall perform and provide all services necessary to provide and maintain quality care and management of the Home consistent with the standards of a reasonably prudent Operator/Manager, including, without limitation, the services described below.

Texas General Land Office and Veterans Land Board -7- RFP No. 1914-JW

2.2.1 Information Systems and Medical Records

Operator shall furnish systems for accounting, billing, purchasing, and bill payment functions for the Home. These systems must be able to interface with and bill Medicare and Medicaid electronically.

To fulfill this requirement, Operator shall acquire and maintain PointClickCare®, or compatible, cloud-based medical record system. Operator shall acquire and maintain the PointClickCare® Direct Messaging module, or a comparable module for transferring veteran and non-veteran resident data to the VA. Operator shall use Transfer Layer Security and other GLO/VLB approved encryption protocols when transferring resident health information.

If applicable, Operator shall cooperate with the preceding operator in facilitating a seamless transition process with respect to such information systems and shall be required to ensure that access to the system is secure from unauthorized third-party access.

The selected Respondent must be prepared to provide the GLO/VLB, at its request, an Information Security Plan as outlined in Section 3.06 of the Sample Contract in Exhibit B. The selected Respondent must also be willing to negotiate with the GLO/VLB, at the GLO/VLB’s sole discretion, a Memorandum of Understanding that outlines the Board’s expectations of the Operator with respect to the privacy and security of protected health information (as such term is defined in HIPAA) and Operator’s information security compliance.

2.2.2 Resident Trust Fund Accounts and Other Accounts

Operator, in accordance with Regulatory Agency standards, shall establish and maintain personal spending accounts and trust funds, on behalf of each Home Resident. Operator shall also establish a Resident Benefit Donation Account, controlled by the Resident Council, for the benefit of the Residents. Operator shall not commingle the funds in these accounts with any other financial account established for the operation of the Home or any other financial account associated with Operator. Operator shall establish and maintain all appropriate security and accounting systems in connection with the trust funds.

2.2.3 Financial Controls

Operator shall establish, supervise and administer the financial controls over the operations and management of the Home, in accordance with GAAP.

2.2.4 Risk Management and Loss Prevention

Operator shall submit, for review by the GLO/VLB, a risk management and loss prevention program designed to prevent the misappropriation, loss, or damage of all GLO/VLB Property, including without limitation, Capital Equipment and/or

Texas General Land Office and Veterans Land Board -8- RFP No. 1914-JW

Capital Improvements. The plan shall be reviewed by Operator on an annual basis.

Operator will be responsible for reimbursing the GLO/VLB for any Capital Equipment or Capital Improvement damaged or destroyed as a result of the acts or omissions of Operator and/or its agents, volunteers, subcontractors, or employees.

2.2.5 Resident Rights

Operator shall implement a complaint resolution program, consistent with HHSC regulations, which allows the residents to express grievances and recommend changes in policies and services in the Home.

As part of its Solicitation Response, Respondent shall submit Respondent’s policy regarding protection of resident rights and a complaint resolution program which shall be consistent with Regulatory Agencies’ procedures, allowing Residents to express grievances and to recommend changes in policies and services. The OSR shall be included in the complaint process.

2.2.5.1 Satisfaction Surveys

The GLO/VLB shall determine the time, frequency, and percentage of recipients (residents and family members) for participation in satisfaction surveys. Survey requirements include the following:

a) The Operator, at its expense, shall contract directly with a company to conduct the surveys and such contract shall be compliant with HIPAA. All survey results shall be sent directly to the GLO/VLB from the contracted survey company.

b) A minimum ten percent of residents and minimum ten percent of the responsible parties shall be asked five questions monthly via telephone. Operator shall require the contracted survey company to compile the monthly survey results into an annual report to be sent directly to the GLO/VLB from the contracted survey company.

c) The GLO/VLB will provide a set of questions to be included in the satisfaction survey in addition to the Operator’s five questions.

2.2.6 Disposition of Remains

Operator shall develop mortuary policies and procedures that ensure the sensitivity and expediency of death notification, documentation, and disposition of remains, including any associated costs. Operator shall develop a plan for deceased residents that do not have a disposition plan on file.

Operator shall submit its mortuary policies and procedures to the GLO/VLB for an annual review.

Texas General Land Office and Veterans Land Board -9- RFP No. 1914-JW

2.2.7 Transfer Agreements

Operator shall maintain written transfer agreements with local civilian and VA hospitals and shall provide or arrange for transportation in the event a Resident requires hospital care. Furthermore, Operator shall maintain contact with the receiving facility to ensure the return of the Resident to the Home at the earliest appropriate date, if applicable.

Operator shall coordinate with various community resources for such transportation services for all Residents as needed to fulfill their medical, therapeutic, and recreational needs and, to the extent unavailable from other community sources, provide such transportation services to residents.

2.2.8 Infection Control

Operator shall institute and maintain an infection control program designed to prevent the development and transmission of disease and infection, including all communicable diseases, that complies with 26 TAC § 554.1601 - .1602 and all other applicable laws and regulations, including without limitation, emergency rules issued by HHSC or other Regulatory Agency related to a communicable disease. Operator shall consider the GLO/VLB’s infection control recommendations but shall select infection control measures in its sole discretion.

2.2.9 Peer Review Committee and Quality Assurance and Performance Improvement

Operator shall establish a peer review and quality assurance committee, as provided for under Chapter 160, Texas Medical Practice Act and Section 161.031, Texas Health and Safety Code, that shall include the Director of Nursing, a primary physician designated by the Home, the OSR, and at least three other staff members of the Operator. Further, the GLO/VLB and Operator shall keep all resident personal, health, and other information, as appropriate, confidential in compliance with HIPAA and other applicable state and federal law.

2.3. SPECIFIC REQUIREMENTS – OPERATIONS

2.3.1 Policies, Procedures, and Implementation

Operator shall implement operational policies and procedures consistent with all Regulatory Agency regulations for the operation of the Home. Operator shall further develop new policies and procedures, as it deems necessary or as required by law, regulation, or the GLO/VLB to ensure the continued operation of the Home.

Operator shall develop, implement, and operate all necessary administrative systems including, but not limited to, accounting, personnel, financial reporting, administrative records, medical records, purchasing, human resources, and information systems.

Texas General Land Office and Veterans Land Board -10- RFP No. 1914-JW

Operator shall submit, for the GLO/VLB’s review, Operator’s current policies, procedures, protocols, plans, and forms, consistent with all applicable procedural and regulatory guidelines, including those described herein, before the execution of any contract resulting from this Solicitation. Operator shall submit to the GLO/VLB copies of all policies, procedures, protocols, plans, and forms at least annually including, as they are enacted, copies of any supplements, changes, or alterations.

2.3.2 Medical Care and Required Services

Operator shall ensure that each resident receives all necessary and appropriate care, including, but not limited to, medical, pharmaceutical, nursing, dental, dietary, recreational, social, psychosocial, and rehabilitative services needed to maintain or improve levels of functioning as required by law, regulation, standard of care, and/or as prescribed or directed by appropriate practitioners. In accordance with VA regulations under Title 38 C.F.R. Part 51, Operator shall, at a minimum, ensure each resident of the Home is provided the following:

a) Primary Physician

Each Resident must have a designated primary physician who will be responsible for the overall medical care of the resident. Residents must be able to be seen or treated by a physician or other health care practitioner of their own choosing at their own expense. Residents may be seen or treated by a physician or other health care practitioner of their own choosing in accordance with federal reimbursement guidelines.

b) Nursing Services

Operator shall ensure that appropriate nursing services are provided twenty-four (24) hours per day, seven (7) days per week. THE MIX AND

NUMBER OF STAFF MUST ADDRESS THE APPROPRIATE

STANDARD OF CARE FOR EACH INDIVIDUAL RESIDENT’S

ACUITY LEVEL AND THE COLLECTIVE RESIDENT

POPULATION’S ACUITY LEVEL (i.e., CMS 3 STAR RATING), AS ESTABLISHED AND REQUIRED BY HHSC. Operator shall work with the GLO/VLB to develop an acuity staffing plan. Operator shall design nursing services to focus on rehabilitative nursing, addressing proper restorative programs, assisting each resident to achieve and maintain the highest possible level of self-care and independence. Operator shall provide nursing services under the supervision of Operator’s Director of Nursing.

c) Rehabilitative and Therapy Services

For the general resident population, Operator shall provide, or cause to be provided: rehabilitative services through the VA, or through an Operator-contracted therapy service provider, including specialized rehabilitative

Texas General Land Office and Veterans Land Board -11- RFP No. 1914-JW services, including physical therapy, speech therapy, and occupational therapy. Operator shall comply with Medicaid and Medicare guidelines and regulations, where applicable.

For seventy percent (70%) Service-Connected Disability veteran residents, Operator shall follow Medicare guidelines for rehabilitative and therapy services.

d) Dental Services

Operator shall provide or cause to be provided dental services for veteran residents through the VA, including emergency and routine services.

Operator shall assist non-veteran private-pay or insured residents in obtaining dental services at no cost to the GLO/VLB or to the Operator.

e) Social Services

Operator shall provide a social services program directed by a licensed social worker that is designed to attain or maintain the highest practicable mental and psychosocial well-being of each resident.

f) Specialized Medical Equipment

Operator shall assist residents in procuring, as required, specialized medical equipment including, but not limited to, prosthetics, orthotics, hearing aids, corrective eye wear, therapeutic mattresses, and specialized beds.

g) Pharmaceuticals

Operator shall provide complete pharmaceutical goods and services for residents, including all over-the-counter medications, medical supplies, and dietary supplements. All prescription medications, over-the-counter medications, and medical supplies shall be ordered, billed, and dispensed under the terms of Attachment A to Exhibit B of the Sample Contract.

h) Psychological Services

Operator shall coordinate and/or contract for psychological services for residents as appropriate

i) Other Services

Operator shall provide other services required to operate a safe, sanitary, and attractive facility, including, but not limited to, grounds maintenance, extermination and pest control, facility-wide housekeeping, barber and beautician services, Alzheimer activities, disbursement of personal funds

Texas General Land Office and Veterans Land Board -12- RFP No. 1914-JW via trust accounts to residents, and any other personal care service reasonably requested by the GLO/VLB, or that may be required by any authorized regulatory agency.

2.3.3 Accounting

Operator shall, at Operator’s expense, provide accounting support to the Home, including timely preparation of all required cost reports and tax returns (including payroll related tax returns) as required by the GLO/VLB. All accounting procedures and systems used in providing accounting support shall be used in accordance with the operating capital and cash programs developed by Operator, which programs shall conform to GAAP or GASB and shall not materially distort income or loss.

Any tax and reimbursement obligations owed due to any governmental programs shall be deemed to be Operating Expenses of the Home and shall be paid by Operator; provided, however, that any reimbursement obligation under the Medicare or Medicaid programs arising through no fault of Operator shall be a responsibility of the GLO/VLB.

2.3.4 Billing Payor Sources During Contract Term

Operator, in the name of and on behalf of the GLO/VLB when appropriate, shall issue billing invoices monthly, or upon the termination of services, to all residents (or residents’ responsible parties or guardians), contractors, vendors, governmental agencies (including the GLO/VLB, VA, Medicare, and Medicaid), or other appropriate parties for all goods and services furnished or provided by Operator.

The revenues from Operator’s negotiated fee arrangement shall be the only source of revenue due to the selected Operator from the GLO/VLB.

Operator shall take all reasonable measures to pursue Medicare or any other third-party payment plan to provide accurate and timely billing and collections for services rendered to all residents each month. Operator, in complying with this provision, shall provide accurate and timely billing and collections to (i) the VA for per-diem reimbursement payments or other benefit claims for all eligible residents;

and (ii) the residents or other entities responsible for the costs of a resident’s care, including Medicare. The Board will only reimburse Operator for billing submitted to Medicare and Medicaid upon receipt of reimbursement from Medicare and Medicaid or as otherwise provided for in the Contract. Operator shall be responsible for any amounts not billed to Medicare, Medicaid or any other third-party payment plan to the extent that Operator is responsible for such. Operator shall be financially responsible for its errors in any billings that it submits to Medicare, Medicaid, and any other third-party payment plan. Operator shall be financially responsible for all funds discovered in any audits that are due to Medicare, Medicaid, and any other third-party payers that must be remitted due to billing errors of Operator.

Operator shall pay all subcontractors the appropriate share of any payment to Operator from the GLO/VLB not later than the 10th day after the date the vendor

Texas General Land Office and Veterans Land Board -13- RFP No. 1914-JW receives the payment in accordance with Sec. 2251.022 of Texas Government Code.

2.3.4.1 Operator Service Invoices to the GLO/VLB

Operator shall invoice the GLO/VLB for services performed for the following payer sources but in accordance with the Cost Proposal provided by the selected Respondent:

a) Fixed Fee: Contractual Monthly Fee.

b) Veteran/Non-Veteran Private Pay: Monthly Variable Fee multiplied by the monthly Veteran Private census (semi and/or private room).

c) Veteran/Non-Veteran Medicare A: Monthly Variable Fee multiplied by the monthly Medicare A census.

d) Medicare B: Reimbursement rate of 80% based on services billed to CMS.

e) Medicare B Co-Insurance: Reimbursement rate of 100% based on the services billed to various third parties.

f) Veteran/Non-Veteran Medicaid: Monthly Variable Fee multiplied by the monthly Medicaid census.

g) Seventy percent (70%) or greater Service-Connected Veterans:

Resident variable rate + covered expenses.

2.3.5 Collections

In accordance with its collections policy, Operator shall, on behalf of the GLO/VLB, take on all reasonable measures to pursue collections on all goods and services provided by Operator, including those billed to Medicare, Medicaid, private insurance, or any other third-party payment arrangement. Operator shall promptly and diligently pursue (but no later than 60 days from the date the last payment was received for any Resident account) all collections on any resident’s unpaid balance to the GLO/VLB.

For ancillary services, Operator shall implement a charge structure for residents of the Home. Operator, in the name of and on behalf of the GLO/VLB, shall promptly issue bills and other necessary reports to appropriate parties and governmental agencies and shall collect accounts and monies owed for goods and services furnished by the Home in the name of and for the account of the GLO/VLB including, without limitation, timely and vigorous enforcement of the rights of the

Texas General Land Office and Veterans Land Board -14- RFP No. 1914-JW

GLO/VLB and the Home as creditors under any contract or in connection with the rendering of any services; provided, however, that any expenses incurred by Operator in so doing shall be treated as Operating Expenses of the Home and payable by Operator.

Operator, in accordance with its admissions and collections policy, shall promptly and diligently pursue all collections on any resident’s unpaid balances due to the GLO/VLB for the care provided from any payor source. If Operator is unable to collect unpaid balances from the resident from whom there is inadequate collection or no reasonable assurance of collection, Operator may discharge such resident in accordance with its approved admissions and/or collections policy, and criteria established by the VA and HHSC.

2.3.6 Census and Financial Data

Operator shall provide the GLO/VLB, through the OSR, with daily census reports for the Home. In addition, Operator shall provide an accurate Monthly Census Report in the name of the GLO/VLB at the end of each month no later than the third business day of the following month for purposes of determining the Operations Fee. Operator shall reconcile the Monthly Census Report to actual census numbers claimed under Medicaid requirements. Operator shall explain and resolve any existing differences between the Monthly Census Report and the census numbers submitted to Medicaid. Operator shall provide census reports in form and content as required by the GLO/VLB and in accordance with HIPAA and all federal, state, and local requirements.

Within 30 days after the end of each calendar month, Operator shall provide the GLO/VLB with:

a) an un-audited balance sheet with respect to the Home, dated the last day of such month;

b) an un-audited statement of income and expenses for such month relating to the operation of each of the Home;

c) a schedule of all accounts receivable depicting the previous month’s ending balance, payments applied during the month, adjustments, current month’s invoice amounts, the new month’s ending balance, and

d) an accounts receivable aging report.

The fiscal year for the Home will begin September 1 and end August 31 of each year. Within 120 days after the end of the fiscal year of the Home, Operator shall provide the GLO/VLB with combined audited financial statements from an auditor that has been pre-approved in writing by the GLO/VLB including (i) a balance sheet of the Home dated the last day of said fiscal year; (ii) a statement of income and

Texas General Land Office and Veterans Land Board -15- RFP No. 1914-JW expense for the year then ended relating to the operation of the Home; (iii) a statement of cash flows for the year then ended for the Home; and (iv) audit adjustments reconciling audited annual financial statements to unaudited monthly financial statements previously provided by Operator. All statements and reports shall be prepared on an accrual basis in accordance with GAAP.

2.3.7 Admissions

Operator shall review the medical and financial eligibility of applicants for admission to the Home, in accordance with standards established by the VA, GLO/VLB, and any other authorized entity.

Operator shall create an admissions review team, including the OSR, to review the medical and financial eligibility of applicants for admission to the Home. The admissions review team shall evaluate applicants in accordance with Operator’s admissions policy. Operator and the GLO/VLB agree to (i) cooperate to facilitate a smooth and orderly admissions process; (ii) timely admit all eligible applicants; and

(iii) seek the fullest possible utilization of the Home, consistent with the policies and procedures of the Texas State Veterans Homes program. The GLO/VLB shall fully comply with state and federal anti-kickback laws, including Chapter 102 of the Texas Occupations Code and 42 U.S.C. §1320a-7b(b).

Upon admission of each Resident, Operator shall create an Individualized Care Plan for the resident. Operator shall also ensure that each resident executes a non-testamentary letter or documents instances in which an admitted resident refused to execute a non-testamentary letter. The non-testamentary letter should describe the process for disbursement of a resident’s funds upon death and the process for disposal of remains should the resident refuse to execute a non-testamentary letter.

Upon admission of a resident as a “Medicaid pending” resident, Operator shall collect the estimated applied income from the resident during the Medicaid application or re-application process (generally a 90-day process). Operator must bill and collect estimated applied income from the resident. Operator must track and monitor Medicaid applications. If a Medicaid application is denied, Operator shall collect resident charges up to the point of rejection for the current month before the resident may re-apply for Medicaid benefits. If the collection efforts are unsuccessful, Operator shall follow its GLO/VLB-reviewed discharge procedures.

2.3.8 Purchasing

Operator shall purchase and pay for all consumables, non-capital improvements, non-capital equipment, information technology equipment (not otherwise provided by the GLO/VLB), utilities, and any other supplies or provisions required for operation of the Home. These expenditures shall be characterized as Operating Expenses. If Operator ceases to operate the Home, the facility must be returned fully stocked and equipped for continued operation, just as it was initially provided

Texas General Land Office and Veterans Land Board -16- RFP No. 1914-JW to Operator. The GLO/VLB shall conduct a starting inventory and a closing inventory for reconciliation purposes during the Operator transition period.

2.3.9 Reports

Operator shall submit all reports required by the GLO/VLB, Regulatory Agencies, or the VA including, but not limited to the following:

a) Adverse Incident Reports: Must be submitted to the GLO/VLB for review not later than 12:00 noon Central Time on the following business day (i.e., Monday – Friday 9:00 am – 5:00 pm).

b) Sentinel Events (as defined in Title 38 C.F.R. §51.120): Must be reported within twenty-four (24) hours of the event, with a copy to the VA included.

Reports must follow Regulatory Agency guidelines for incident reporting.

2.3.10 Utilities

Operator shall provide all utilities and fuels, including, but not limited to: water, natural gas, electricity, sewer, diesel oil, gasoline, telephone, cable television, and garbage disposal. Notwithstanding the preceding sentence, the GLO/VLB may elect to contract directly with a local utility provider for the electricity and natural gas needs of the Home, if such direct contract is reasonably expected to result in reduced charges for such utilities. All utility accounts shall be in the name of the GLO/VLB rather than the Operator.

2.3.11 On-Site Representative (OSR)

The OSR, a designated GLO/VLB employee, maintains an office in the Home to oversee the monitoring of the contract resulting from this Solicitation. Operator shall pay administrative expenses of the OSR including office supplies, materials, telephone and internet equipment and service, and any other reasonably related expenses.

2.3.12 Monitoring

In addition to reports, reviews, and surveys conducted by Regulatory Agencies, the GLO/VLB conducts reviews on the provision of operational, health, and life safety code services provided by the Operator. Operator shall cooperate with the GLO/VLB during such reviews.

2.3.13 Volunteer Programs

Operator shall recruit and coordinate volunteers to enhance all residents’ quality of life but in all instances subject to compliance with any COVID-19 guidance and

Texas General Land Office and Veterans Land Board -17- RFP No. 1914-JW regulations issued by any applicable Regulatory Agency. Volunteer requirements are outlined in the licensing requirements for Medicare/Medicaid facilities.

2.3.14 Community Development and Transportation

Operator shall coordinate with various community sources for transportation services for all residents, as needed to fulfill their medical, therapeutic, and recreational needs and, to the extent unavailable from other community sources, provide such transportation services to residents. Operator shall provide and maintain at its own expense at least one (1) wheelchair-accessible passenger van or bus for resident transportation. Operator shall hold title to all vans or buses used for resident transportation. Operator shall pay all fuel, maintenance, registration, and inspections costs.

2.3.15 Janitorial and Laundry Services

Operator shall provide full janitorial services, including trash removal, extermination and pest control, facility-wide housekeeping, and facility-wide laundry services, including personal laundry services for the residents.

2.4. SPECIFIC REQUIREMENTS – PERSONNEL AND STAFFING

2.4.1 Personnel

Operator shall employ and maintain appropriate staffing which exceeds the level necessary to maintain compliance with VA guidelines for State Veterans Homes, Title XVIII (18) (Medicare) of the Social Security Act, Texas Health and Human Services Commission regulations, and regulations of any other applicable regulatory agency, including Title 26, Part 1, Chapter 554 of the Texas Administrative Code. Operator shall: (i) staff to acuity at the Home (i.e., CMS 3 star rating); (ii) work with the GLO/VLB and/or its authorized consultant, to develop an acuity staffing plan based on total resident census and each resident’s Individualized Care plan; (iii) recruit, employ, train, promote, direct, discipline, suspend, and discharge all personnel (except those listed in this section), in compliance with all applicable federal and state employment laws; (iv) establish salary levels, personnel policies, and employee benefits; (v) establish employee performance standards, as needed during the term of this Agreement, to ensure the efficient operation of all departments within, and services offered by, the Home;

and (vi) submit a staffing proposal per unit and per shift per day for one month based on a) the Home’s current census in Exhibit E and b) the Home at a minimum 90 percent occupancy in accordance with the staffing development plan provided as required by this Solicitation in Section 2.4.8.

Operator must employ a Medical Director (who may be an employee of, or an independent contractor with, Operator), an Administrator, and a Director of Nursing, all of whom must be properly licensed and possess the appropriate

Texas General Land Office and Veterans Land Board -18- RFP No. 1914-JW education and experience in the long-term health care field. Pursuant to Chapter 657 of the Texas Government Code, a veteran’s employment preference shall be afforded to qualifying individuals in all Home employment opportunities, as applicable. In order to ensure the continuing safety and health care of the residents of the Home, upon termination of this Agreement for any cause, the GLO/VLB or the successor Operator selected by the GLO/VLB may, in its sole discretion, offer employment to any or all employees of Operator who are regularly employed in providing services at the Home.

2.4.2 Required Staffing

Operator shall employ and staff the Home in accordance with VA and HHSC regulations. Additionally, Operator shall employ a Texas licensed:

a) Medical Director;

b) Nursing Home Administrator;

c) Director of Nursing; and

d) Director of Maintenance.

The Medical Director, Nursing Home Administrator, and Director of Nursing shall meet each resident and become familiar with each resident’s medical history, needs, and Individualized Care Plans.

2.4.3 Orientation and Training

Operator shall provide all personnel with an employee orientation and continuing education program regarding the Home policies, procedures, and practices including annual training in residents’ rights, disaster preparedness, cardio-pulmonary resuscitation, first aid, Alzheimer’s training, and HIPAA compliance.

Operator shall submit an orientation and…