Document ID: RFP 074 2700000013 Page: 1

Commonwealth of Kentucky

SOLICITATION MODIFICATION

Modification: Yes Version #: 2

TITLE: Physician Services

Date Issued:

08/12/2026 Record Date:

08/11/2026

Solicitation Closes Date:

08/19/2026 Time:

15:00

Solicitation No:

RFP 074 2700000013

Reason for Modification

Modification to answer questions.

Online Bidding Prohibited: Yes

For Information Call:

DONYA GOODE

270-322-3523

Bid Receiving Location:

Radcliff Veterans Center Bid Receiving 100 Veterans Drive

Radcliff KY 40160

Vendor Customer Number:

Vendor Name:

Phone Number:

Fax Number:

Email Address:

Ordering

Address:

City, State, Zip:

Contact Name:

Contact Email:

Contact Phone Number:

Payment

Address:

City, State, Zip:

Contact Name:

Contact Email:

Contact Phone Number:

Ownership Type

__ Sole Proprietorship __ Partnership __ Corporation __ Other_________________________

SIGNATURE OF AUTHORIZED AGENT IS REQUIRED UNLESS RESPONSE

IS SUBMITTED ELECTRONICALLY. FAILURE TO SIGN SHALL RENDER

THE BID INVALID.

Signature X_________________________________________ FEIN#____________________ Date____________

All offers subject to all terms and conditions contained in this solicitation.

Document ID: RFP 074 2700000013 Page: 2

Line Items

Commodity Group: Default

Line CL Description Quantity UOM Unit Cost Line Total or Contract Amnt

1 Professional Medical Services

Comm Code Comm Description Manufacturer Model # Manuf Part #

94874PS PSC-Professional Medical Services (Including Physicians, Pha

Extended Description RVC Physician Services

Shipping Information Radcliff Veterans Center Shipping 100 Veterans Drive

Radcliff KY 40160

Billing Information Radcliff Veterans Center Billing 100 Veterans Drive

Radcliff KY 40160

Document ID: RFP 074 2700000013 Page: 3

Submission Checklist

The following items will be required to be submitted with bid:

Item Proposed technical solution. Submit by closing date and time.

Proposed cost solution. SUbmit by closing date and time.

Oral Presentation - Optional

Revised February 2026

PROPOSAL SUBMISSION CHECKLIST

The vendor MUST include the following with the proposal submission.

If the items highlighted below are not submitted with the proposal submission, the Commonwealth MUST deem the proposal non-responsive and SHALL NOT consider for award.

All other items MUST be submitted prior to award.

_____ SIGNED AND COMPLETED SOLICITATION –Section(s) 8.00 and 8.10 of this RFP

(not required if submitting electronically)

_____ *PROPOSED SOLUTION (TECHNICAL) UNDER SEALED COVER AND BY

CLOSING DATE --Section(s) 8.00 and 8.10 of this RFP

_____ *PROPOSED SOLUTION (COST) UNDER SEALED COVER AND BY CLOSING

DATE -- Section(s) 8.00 and 8.10 of this RFP

_____ TRANSMITTAL LETTER – Section 8.20 of this RFP

_____ PROOF OF REGISTRATION WITH SECRETARY OF STATE BY A FOREIGN

ENTITY -- Section 8.00 of the Personal Service Contract Terms and Conditions of this

RFP

_____ REQUIRED AFFIDAVIT(S) – Section 8.20 of this RFP

*The Commonwealth defines SEALED as “a closure that must be broken to be opened and that thus reveals tampering” (Merriam-Webster Dictionary, https://www.merriam-webster.com/ dictionary/seal

REQUEST FOR PROPOSAL

FOR

PERSONAL SERVICE CONTRACT

Kentucky Department of Veterans Affairs/Carl M. Brashear Radcliff Veterans Center Outsourced Physician Services

Document Phase Document Description Page 4

2700000013 Final Physician Services Total Pages: 43 https://www.merriam-webster.com/dictionary/seal https://www.merriam-webster.com/dictionary/seal

RFP 2700000013

Addendum 1 This addendum in bold is to answer questions in response to the solicitation pages 33 - 35.

This document constitutes a Request for Proposals for a Personal Service Contract from qualified individuals and organizations to furnish those services as described herein for the Commonwealth of Kentucky, Kentucky Department of Veterans Affairs/Carl M. Brashear Radcliff Veterans Center.

Offerors are advised that any personal service contract resulting from this RFP must comply with all applicable provisions of KRS 45A and KRS 12.210 prior to becoming effective.

A contract, based on this RFP, may or may not be awarded. Any contract award from this RFP is invalid until properly approved and executed by the Finance and Administration Cabinet and filed with the Legislative Research Commission, Government Contract Review Committee.

1.00 Purpose and Background

Carl M. Brashear Radcliff Veterans Center (RVC) is a long-term care facility with a capacity of 120 Veterans. We are looking for general practice Physician Services to cover RVC needs. Carl M.

Brashear Radcliff Veterans Center may/or may not award this contract as a multi-vendor contract.

The purpose of the proposal is to provide an adequate level of Physician Coverage when needed.

2.00 Scope of Work

Physicians shall provide services to the Veterans of Carl M. Brashear Radcliff Veterans Center to include evaluation and management of patient medical care for scheduled and acute encounters.

Physician Services shall follow all state and Federal Guidelines/regulations as they pertain to long-term care facilities.

Physicians will follow regulations set forth by Centers for Medicare and Medicaid, Veterans Affairs regulatory guidelines, and those within his/her scope of practice that includes but is not limited to:

Accepting responsibility for initial and subsequent veteran care Supporting discharges and transfers Making periodic, pertinent patient visits in the facility Providing appropriate veteran care Providing appropriate, timely medical orders Providing appropriate, timely, and pertinent documentation Maintaining appropriate conduct and compliance Assess new admissions in a timely fashion according to individual’s medical stability Examine a medically unstable individual within 24 hours of admission Seek, provide, and analyze information regarding a veteran’s current status, recent history, and medications and treatments to enable safe, effective continuing care and to support facility compliance with regulations and care standards Assist staff in determining or confirming the appropriate level of care for a new admission Attending Physician or covering practitioner will authorize timely admission orders

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2700000013 Final Physician Services Total Pages: 43

For a veteran who is to be transferred to the care of another healthcare practitioner, the current Attending Physician will continue to provide all necessary medical care and services, pending transfer, until another physician has accepted responsibility for the patient.

Attending Physician will follow up (as needed) with another physician or health- care practitioner who is to assume the care of an acutely ill or unstable patient, either in the facility or in another setting.

Attending Physician will provide documentation and/or other information needed for care continuity at a receiving facility.

Attending Physician or the physician extender in consultation with the attending physician must complete a discharge summary upon transfer or discharge, not to exceed 24 hours after the transfer or discharge. The attending physician will complete an attestation affirming his or her involvement/ consultation. If the veteran has expired, a discharge summary must be completed within 30 days of the veteran’s passing.

Attending Physician will visit veterans in a timely fashion, consistent with applicable state and federal requirements, and depending on the individual’s medical stability, recent and previous medical history, and the presence of medical conditions or problems that cannot be handled readily by phone (see policy on Veteran Visits).

a. The visit schedule will be at least every 30 days for the first 90 days after admission, and then at least every 60 days thereafter.

b. After the initial physician visit, a Nurse Practitioner or other midlevel practitioner, not directly employed by the facility but under the Physician’s supervision can make scheduled visits.

c. The physician visit requirements must be met by the physician and may not be altered with Nurse Practitioner, Physician Assistant, or Clinical Nurse Specialist when he/she is employed by the facility. They Physician Assistant, Nurse Practitioner, and Clinical Nurse Specialist may perform and sign other medically necessary visits and orders.

Physician and the ARNP will maintain progress notes that cover pertinent aspects of a veteran’s medical condition and his/her current status and goals.

a. Periodically, the Physician’s documentation should indicate review and acknowledgement of a veteran’s program of care.

b. The review should be extensive enough to ensure that the current approach overall is consistent with the individual’s medical condition, goals, prognosis, and wishes.

3. During visits, the Attending Physician will determine each veteran’s overall condition and the status of specific medical issues by seeing and evaluating the individual, speaking with staff (as needed) and (as indicated) with veteran representative/family or possibly friends, and reviewing relevant information.

At the time of a visit, the Physician will respond to questions and concerns such as the status of medical issues (including any acute episodes of illness since the last visit), diagnostic test results, impact of medical condition on the individual’s functional, physical, or cognitive status, and continued relevance of current medications and treatments.

At each visit, the Attending Physician will provide a progress note (written, typed, or electronic) in a timely manner for placement in the medical record.

a. The note entered at the time of the visit.

b. Over time, these progress notes should address significant active problems and risk factors, reasons for changing or maintaining current treatments or medications, and an evaluation of how medical treatments relate to the individual’s overall function and quality of life.

Document Phase Document Description Page 6

The Attending Physician will designate an alternate physician or another appropriately licensed practitioner to respond in an appropriate, timely manner in case the Attending Physician is unavailable.

The Attending Physician will update the facility about his/her current address and phone numbers (mobile or landline) to enable timely communications, as well as the current address and phone numbers of designated alternate practitioners (such as Nurse Practitioners and Physician Assistants).

The Attending Physician will help ensure that alternate covering practitioners provide adequate and timely support while covering and will intervene with them if the facility identifies problems regarding such coverage.

The Attending Physician will notify the facility, in advance, of extended absence, such as vacation, and of coverage arranged during such periods.

The Attending Physician will inform covering practitioners about veterans who need medical follow-up during their on-call time.

The Attending Physician will perform accurate, timely, and relevant medical assessments as needed.

The Physician will verify and clarify symptoms, problems, and diagnoses, and will help establish a realistic prognosis and care goals.

In consultation with facility staff, the Physician will identify appropriate treatments and services, consistent with each individual’s diagnoses, condition, prognosis, and wishes.

In consultation with facility staff, the Physician will verify that treatments and services, including rehabilitation services, are medically necessary and appropriate in accordance with relevant criteria.

The Physician will respond in an appropriate time frame to emergency and routine notification by staff.

The Physician will address laboratory and other diagnostic test results in a timely manner, based on the veteran’s condition and the clinical significance of the results.

a. The Physician will analyze abnormal test results and explain the medical rationale for subsequent interventions or decisions not to intervene based on those results, especially when that basis is not readily apparent.

The Physician will respond to notification of and will assess and manage acute and significant changes in veteran condition.

The Physician will guide the staff, and help document, the basis for decisions and orders regarding options for life-sustaining treatments and other ethical issues, consistent with applicable standards, laws, and regulations, and with veteran wishes.

a. This includes helping veterans or veteran representatives formulate advance directives and care instructions, and helping to identify individuals for whom aggressive medical interventions may not be beneficial.

b. The Physician will provide orders to ensure that individuals have appropriate comfort and supportive measures as needed; for example, to address pain, or in palliative or end-of-life situations.

The Physician will periodically review all medications prescribed for his/her patients and will monitor both for continuing indications and for possible adverse drug reactions.

a. The medication review should take into account observations and concerns offered by Nurses, consultant pharmacists and others regarding beneficial and possible adverse impacts of medications on the veteran.

The Attending Physician will provide timely and appropriate medical orders.

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Medication and treatment orders will be clear, legible, and will include the medication indication, strength, and formulation (if alternate forms are available); route of administration; frequency, and the timing and duration of administration.

The Physician will verify the accuracy of verbal and telephone orders when they are given and will authenticate, co-sign, and date them in a timely manner no later than the next visit to the veteran.

The Physician will provide documentation required to explain medical decisions and to help the facility comply with its legal and regulatory requirements.

The Physician will complete death certificates in a timely manner, including all information required of a physician.

The Physician will abide by pertinent facility and medical policies/procedures and will collaborate with the Medical Director to help the facility provide high-quality care.

The Physician should contact the Medical Director if he/she believes that a policy, expectation, or requirement is incorrect or unwarranted.

The Physician will keep the well-being of veterans as the principal consideration in his/her decisions.

The Physician will be alert to observed or suspected violations of veteran rights, including abuse or neglect, and will report these to the Medical Director or other appropriate individuals.

The Physician will maintain a courteous, professional level of interaction with facility staff, patients, families, facility employees, and management.

The Physician or staff should inform the Medical Director of disputes or problems that cannot be readily resolved by the involved parties.

Nursing facility rounds as needed and per regulations.

Resident Charting Provide 24 hour/day, 365 days per year on-call service

Coordinate Emergency care for RVC residents who may be admitted to a hospital

Coordinate transport of Carl M. Brashear Radcliff Veterans Center residents to the closest acute care setting

Coordinate resident care of Carl M. Brashear Radcliff Veterans Center resident in an acute care setting

Supervising the medical care of resident’s means participating in the resident’s assessment and care planning, monitoring changes in resident’s medical condition, and providing consultation or treatment when contacted by the facility. It also includes, but is not limited to prescribing medications and therapy, ordering a resident’s transfer to the hospital, conducting required routine visits or delegating to and supervising follow-up visits by APP(Advance Practice Providers), NPP(Non-Physician Providers), or PE(Physician Extenders).

It is the responsibility of both the facility and the physician to ensure that a physician is always available for the care of our Veterans. In the event that this physician is unreachable or unavailable, this attending physician may designate another physician to act on his/her behalf while unreachable or unavailable. This physician will be responsible for verifying credentialing of the backup and will have ultimate responsibility for the actions taken by the physician who is covering during this period of unavailability.

Document Phase Document Description Page 8

Physician must be qualified to provide services in the Commonwealth of Kentucky. Physician must be licensed to practice in the Commonwealth of Kentucky.

The physician provider must not be identified as an excluded individual or entity by Medicare or Medicaid authorities.

Provide service to all residents without regard to race, color, creed, national origin, age, sex, religion or handicap.

The billing shall be handled by contractor under either Medicare Part B or private insurance according to federal regulations. The Contractor shall not bill RVC residents unless as noted in the document.

RVC is responsible for the charges of the Prevailing Rate Residents and will send a list of current Prevailing Rate Residents to the contractor weekly.

Under the Health Insurance Portability and Accountability Act of 1996 and the final regulations promulgated thereunder, as amended from time to time (“HIPPA”), comply with the applicable provisions including all data, documents, discussion, or other information developed or received by the awarded Vendor or provided for performance of agreement are deemed confidential and shall not be disclosed by awarded Vendor to any other party than the Commonwealth of Kentucky.

All representatives must have the mandatory background checks required by the OBRA Regulations 483.13(c)(1)(ii); 483.75(b); 483.75(g)(1); 483.75(g)(2). Vendor must also perform credentialing review on all licensed personnel to ensure they meet the state requirements in their field of practice (This includes checking the OIG and SAM exclusion lists). Vendor is responsible for ensuring none of their employees, representatives, independent contractors has been suspended, debarred, excluded or ineligible to participate in federal health care programs, which includes Medicaid and Medicare.

Vendor will provide two (2) work references on candidate, copy of drug test, copy of background check (National Background check with fingerprinting) KARES is preferred, and copy of tuberculosis test (must be a two-step completed in the past year).

Any physician that comes on-site must go through an on-site orientation, which will be provided by the RVC. Each physician that works for the RVC must provide required credentialing paperwork per VA guidelines. This will include a copy of their licensure, copy of relevant school transcript, other relevant certifications, medical self-attestations filled out (provided by RVC), signed scope of work (form provided by RVC), resume, and filled out work information form (provided by RVC).

Medical Director must take part in all mandatory trainings provided by the RVC.

RVC RESPONSIBILTY

Carl M. Brashear Radcliff Veterans Center shall provide personnel services, space and equipment as are reasonably necessary for the proper and efficient operation of Physicians. This includes but is

Document Phase Document Description Page 9 not limited to support services such as Nursing Administration, Accounting, Purchasing, Medical Records, Patient Transportation, etc. and adequate space and equipment.

The following Guidelines and Regulations are provided to inform the Provider of the requirements of this position and the responsibilities for the Provider under CMS guidelines and regulations.

Guidelines/Regulations as they pertain to long-term care Facilities include but not limited to:

F710 §483.30 Physician Services A physician must personally approve in writing a recommendation that an individual be admitted to a facility. Each resident must remain under the care of a physician. A physician, physician assistant, nurse practitioner, or clinical nurse specialist must provide orders for the resident’s immediate care and needs.

§483.30(a) Physician Supervision. The facility must ensure that §483.30(a) (1) The medical care of each resident is supervised by a physician.

§483.30(a)(2) Another physician supervises the medical care of residents when their attending physician is unavailable.

INTENT §483.30(a) The intent of this regulation is to ensure the medical supervision of the care of each resident by a physician and that orders for the resident’s immediate care and needs are provided throughout the resident’s stay.

DEFINITIONS §483.30(a) “Attending physician” refers to the primary physician who is responsible for managing the resident’s medical care. This does not include other physicians whom the resident may see periodically, such as specialists.

“Non-physician practitioner (NPP)” is a nurse practitioner (NP), clinical nurse specialist (CNS), or physician assistant (PA).

“Nurse practitioner” is a registered professional nurse currently licensed to practice in the State and who meets the State’s requirements governing the qualification of nurse practitioners.

“Clinical nurse specialist” is a registered professional nurse currently licensed to practice in the State and who meets the State’s requirements governing the qualifications of clinical nurse specialists.

“Physician assistant” is a person who meets the applicable State requirements governing the qualifications for assistants to primary care physicians.

GUIDANCE §483.30(a) A physician’s personal approval of an admission recommendation must be in written form. The written recommendation for admission to the facility must be provided by a physician and cannot be provided by a NPP. This may be accomplished through a hospital transfer summary written by a physician, paperwork completed by the resident’s physician in the community, or other written

Document Phase Document Description Page 10 form by a physician. If a physician does not provide a written recommendation that the individual be admitted to the facility prior to the resident’s admission, the physician’s admission orders for the resident’s immediate care as required in §483.20(a) will be accepted as “personal approval” of the admission if the orders are provided by a physician. Admission orders in lieu of a physician’s written recommendation for admission to the facility cannot be provided by a NPP.

Generally, the term “attending physician” or “physician” may also include a NPP involved in the management of the resident’s care, to the extent permitted by State law. However, when the regulation specifies a task to be completed “personally” by the physician, that task may not be delegated to a NPP.

Supervising the medical care of resident’s means participating in the resident’s assessment and care planning, monitoring changes in resident’s medical status, and providing consultation or treatment when contacted by the facility. It also includes, but is not limited to, prescribing medications and therapy, ordering a resident’s transfer to the hospital, conducting required routine visits or delegating to and supervising follow-up visits by NPPs.

It is the responsibility of the facility to ensure that another physician supervises the care of residents when the attending physician is unavailable. The attending physician may designate another physician to act on his/her behalf when unavailable. If the attending physician is unavailable and does not designate another physician to act on his/her behalf, or the designated physician is unavailable, the facility must have a physician available who will supervise the care of the attending physician’s residents.

F711 §483.30(b) Physician Visits The physician must— §483.30(b)(1) Review the resident’s total program of care, including medications and treatments, at each visit required by paragraph (c) of this section.

§483.30(b)(2) Write, sign, and date progress notes at each visit; and

§483.30(b)(3) Sign and date all orders except for influenza and pneumococcal vaccines, which may be administered per physician-approved facility policy after an assessment for contraindications.

INTENT §483.30(b) The intent of this regulation is to have the physician take an active role in supervising the care of the residents. Physician visits should not be superficial visits but must include an evaluation of the resident’s condition and total program of care, including medications and treatments, and a decision about the continued appropriateness of the resident’s current medical regimen.

GUIDANCE §483.30(b) Except where the regulation specifies the task must be completed personally by the physician, the term “attending physician” or “physician” also includes a non-physician practitioner (NPP) involved in the management of the resident’s care, to the extent permitted by State law.

Total program of care includes all care the facility provides residents to maintain or improve their highest practicable physical, mental, and psychosocial well-being, as defined by the comprehensive

Document Phase Document Description Page 11 assessment and plan of care. Care includes medical services and medication management, physical, occupational, and speech/language therapy, nursing care, nutritional interventions, social work, and activity services that maintain or improve psychosocial functioning.

During required visits, the physician must document a review of the resident’s total program of care, including the resident’s current condition, progress, and problems in maintaining or improving their physical, mental, and psychosocial well-being and decisions about the continued appropriateness of the resident’s current medical regimen. The physician need not review the total plan of care at each visit but must review the total plan of care at visits required by §483.30(c), F712.

Progress notes must be written, signed, and dated at each physician visit, which may be done in a physical chart or electronic record, in keeping with facility practices.

During visits, the physician must also sign and date all orders, except for influenza and pneumococcal vaccinations, which may be administered per physician-approved facility policy after an assessment for contraindications. This includes co-signing orders written by NPPs, qualified dietitians, other clinically qualified nutrition professionals and qualified therapists, as required by state law.

In cases where facilities have created the option for a resident’s record to be maintained by computer, rather than hard copy, electronic signatures are acceptable. See Guidelines for §483.70(i) (1), F842, for information on facility safeguards concerning electronic signatures.

Physician orders may be transmitted by facsimile machine if the following conditions are met.

The physician should have signed and retained the original order from which the facsimile was transmitted and be able to provide it upon request. Alternatively, the original may be sent to the facility at a later time and substituted for the facsimile.

The facility should photocopy the faxed order if the faxed order is subject to fading over time. The facsimile copy can be discarded after facility photocopies it.

It is not necessary for a physician to re-sign the facsimile order when he/she visits the facility.

When rubber stamp signatures are authorized by the facility’s management, the individual whose signature the stamp represents shall place in the administrative offices of the facility a signed statement to the effect that he/she is the only one who has the stamp and uses it. A list of computer codes, identification numbers and/or written signatures must be readily available and maintained under adequate safeguards. Adequate safeguards may include, but are not limited to, locked in a drawer, locked in a location that is accessible only by appropriate staff as defined by the facility;

or available on a protected electronic site accessible by appropriate staff as defined by the facility.

F712 §483.30(c) Frequency of physician visits §483.30(c)(1) The residents must be seen by a physician at least once every 30 days for the first 90 days after admission, and at least once every 60 days thereafter.

§483.30(c)(2) A physician visit is considered timely if it occurs not later than 10 days after the date the visit was required.

§483.30(c)(3) Except as provided in paragraphs (c)(4) and (f) of this section, all required physician visits must be made by the physician personally.

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In a NF the physician visit requirement may be satisfied in accordance with State law by a NPP who is not an employee of the facility but who is working in collaboration with a physician and who is licensed by the State and performing within the state’s scope of practice. (See §483.30(f)).

In a NF, medically necessary visits performed by NPPs employed by the facility, may not take the place of physician required visits, nor may the visit count towards meeting the physician visit schedule prescribed at §483.20(c)(1).

§483.30(c)(4) At the option of the physician, required visits in SNFs, after the initial visit, may alternate between personal visits by the physician and visits by a physician assistant, nurse practitioner or clinical nurse specialist in accordance with paragraph (e) of this section.

DEFINITIONS §483.30(c) Must be seen, for purposes of the visits required by §483.30(c)(1), means that the physician or NPP must make actual face-to-face contact with the resident, and at the same physical location, not via a telehealth arrangement. There is no requirement for this type of contact at the time of admission, since the decision to admit an individual to a nursing facility (whether from a hospital or from the individual’s own residence) generally involves physician contact during the period immediately preceding the admission.

“Non-physician practitioner (NPP)” means a nurse practitioner (NP), clinical nurse specialist (CNS) or physician assistant (PA).

GUIDANCE §483.30(c) The timing of physician visits is based on the admission date of the resident.

In a SNF, the first physician visit (this includes the initial comprehensive visit) must be conducted within the first 30 days after admission, and then at 30-day intervals up until 90 days after the admission date. After the first 90 days, visits must be conducted at least once every 60 days thereafter.

Permitting up to 10 days’ slippage of a due date will not affect the next due date. However, do not specifically look at the timetables for physician visits unless there is indication of inadequate medical care. The regulation states that the physician (or his/her delegate) must visit the resident at least every 30 or 60 days. There is no provision for physicians to use discretion in visiting at intervals longer than those specified at §483.30(c), F712. Although the physician may not delegate the responsibility for conducting the initial visit in a SNF, NPPs may perform other medically necessary visits prior to and after the physician’s initial visit, as allowed by State law.

After the initial physician visit in SNFs, where States allow their use, a NPP may make every other required visit. (See §483.30(e), F714 Physician delegation of tasks in SNFs.) These alternate visits, as well as medically necessary visits, may be performed and signed by the NPP. (Physician co-signature is not required, unless required by State law).

In SNFs and NFs, facility policy that allows NPPs to conduct required visits, and/or allows a 10-day slippage in the time of the required visit, does not relieve the physician of the obligation to visit a resident personally when the resident’s medical condition makes that visit necessary.

Table 1: Authority for Non-physician Practitioners to Perform Visits, Sign Orders and Sign Medicare Part A Certifications/Re-certifications when Permitted by the State

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Initial Comprehensive

Visit /Orders

Other Required Visits^

Other Medically Necessary Visits

& Orders+

Certification/ Recertification

SNFs

PA, NP & CNS

employed by the facility

May not perform/ May not sign

May perform alternate visits

May perform and sign May not sign

PA, NP & CNS

not a facility employee

May not perform/ May not sign

May perform alternate visits

May perform and sign May sign subject to State

Requirements

NFs

PA, NP, & CNS

employed by the facility

May not perform/ May not sign

May not perform

May perform and sign Not applicable

PA, NP, & CNS

not a facility employee

May perform/ May sign*

May perform May perform and sign Not applicable

*A NPP may provide admission orders if a physician personally approved in writing a recommendation for admission to the facility prior to admission. For additional requirements on physician recommendation for admission and admission orders, see §483.30(a), F710.

^Other required visits are the physician visits required by 483.30(c)(1) other than the initial comprehensive visit.

+Medically necessary visits are independent of required visits and may be performed prior to the initial comprehensive visit.

±Though not part of a compliance determination for this section, this requirement is provided for clarification and relates specifically to coverage of a Part A Medicare stay, which can take place only in a Medicare-certified SNF.

In a facility where beds are dually certified under Medicare and Medicaid, the facility must determine how the resident stay is being paid in order to identify whether physician delegation of tasks is permissible and if a NPP may perform the tasks. For example:

For residents in a Part A Medicare stay, the NPP must follow the requirements for physician services in a SNF. This includes, at the option of a physician, required physician visits alternated between personal visits by the physician and visits by a NPP after the physician makes the initial comprehensive visit; and For residents in a Medicaid stay, the NPP must follow the requirements for physician services in a NF. A NPP who is not employed by the facility and is working in collaboration with a physician may perform any required physician task for a resident in a Medicaid-stay, at the option of the

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State. (NPPs employed by the facility may not perform required physician visits but may perform other medically necessary visits.

It is expected that visits will occur at the facility.. If the facility has established policy that residents leave the grounds for medical care, the resident does not object, and this policy does not infringe on his/her rights including the right to privacy, there is no prohibition to this practice. The facility should inform the resident of this practice, in accordance with F580, §483.10(g)(14), (15), (16), Notice[SP1.1] of rights and services.

Certifications/Re-certifications in SNFs: Under 42 C.F.R. §424.20, certifications and re-certifications are required to verify that a resident requires daily skilled nursing care or rehabilitation services. NPs, CNSs, and PAs who are not employed by the facility and who are working in collaboration with a physician may sign the required initial certification and re-certifications when permitted under the scope of practice for the State. 42 C.F.R. §424.20(e)(2).

§483.30(d) Availability of physicians for emergency care The facility must provide or arrange for the provision of physician services 24 hours a day, in case of emergency.

GUIDANCE §483.30(d) If a resident’s attending physician is unavailable, the facility should attempt to contact the physician covering for the attending physician before assuming the responsibility of contacting another physician.

Arranging for physician services may include assuring resident transportation to a hospital emergency room or other medical facility if the facility is unable to meet the medical need at the facility. The provision of transportation does not remove the facility’s responsibility to have a physician available, 24 hours a day, to respond to emergencies that do not require medical care in an alternative setting.

F714 §483.30(e) Physician delegation of tasks in SNFs.

§483.30(e)(1) Except as specified in paragraph (e)(4) of this section, a physician may delegate tasks to a physician assistant, nurse practitioner, or clinical nurse specialist who—

(i) Meets the applicable definition in §491.2 of this chapter or, in the case of a clinical nurse specialist, is licensed as such by the State.

(ii) Is acting within the scope of practice as defined by State law; and

(iii) Is under the supervision of the physician.

§483.30(e)(4) A physician may not delegate a task when the regulations specify that the physician must perform it personally, or when the delegation is prohibited under State law or by the facility’s own policies.

§483.30(f) Performance of physician tasks in NFs.

At the option of State, any required physician task in a NF (including tasks which the regulations specify must be performed personally by the physician) may also be satisfied when performed by

Document Phase Document Description Page 15 a nurse practitioner, clinical nurse specialist, or physician assistant who is not an employee of the facility but who is working in collaboration with a physician.

INTENT §483.30(e)(1)&(4) To allow the physician, under certain conditions, to delegate tasks to a nurse practitioner, clinical nurse specialist or physician assistant, working under the physician’s supervision.

DEFINITIONS §483.30(e)(1)&(4)

“Clinical nurse specialist” is a registered professional nurse currently licensed to practice in the State and who meets the State’s requirements governing the qualifications of clinical nurse specialists.

“Nurse practitioner” is a registered professional nurse who is currently licensed to practice in the State, who meets the State’s requirements governing the qualification of nurse practitioners and who meets one of the following conditions:

(1) is currently certified as a primary care nurse practitioner by the American Nurses’ Association or by the National Board of Pediatric Nurse Practitioners and Associates; or

(2) has satisfactorily completed a formal 1 academic year educational program that (i) prepares registered nurses to perform an expanded role in the delivery of primary care;

(ii) includes at least 4 months (in the aggregate) of classroom instruction and a component of supervised clinical practice; and (iii) awards a degree, diploma or certificate to persons who successfully complete the program; or

(3) has successfully completed a formal educational program (for preparing registered nurses to perform an expanded role in the delivery of primary care) that does not meet the requirements above and has been performing an expanded role in the delivery of primary care for a total of 12 months during the 18-month period immediately preceding September 22, 2006.

“Physician assistant” is a person who meets the applicable State requirements governing the qualifications for assistants to primary care physicians, and who meets at least one of the following conditions:

(1) is currently certified by the National Commission on Certification of Physician Assistants to assist primary care physicians; or

(2) has satisfactorily completed a program for preparing physician’s assistants that (i) was at least 1 academic year in length; (ii) consisted of supervised clinical practice and at least 4 months (in the aggregate) of classroom instruction directed toward preparing students to deliver health care; and

(iii) was accredited by the American Medical Association’s Committee on Allied Health Education and Accreditation; or

(3) Has satisfactorily completed a formal educational program (for preparing physician assistants) that does not meet the requirements above and has been assisting physicians for a total of 12 months during the 18-month period that ended on December 31, 1986.

“Non-physician practitioner (NPP)” is a nurse practitioner (NP), clinical nurse specialist (CNS), or physician assistant (PA) as defined above.

GUIDANCE §483.30(e)(1)&(4)

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The extent to which physician services may be delegated to NPPs in SNFs is governed by the provisions of §483.30(e), while the extent to which these services may be performed by NPPs in NFs is governed by the provisions of §483.30(f). (Refer to table in F712).

In SNFs, when personal performance of a particular task by a physician is specified in the regulations, performance of that task cannot be delegated to anyone else. The tasks of examining the resident, reviewing the resident’s total program of care, writing progress notes, and signing orders may be delegated unless prohibited by State law or facility policies.

DEFINITIONS §483.30(f) “Collaboration” is a process often governed by the laws of a given State in which a non- physician practitioner (NPP) works with one or more physicians to deliver health care services within the scope of the NPP’s expertise, with medical direction and appropriate supervision as provided for in jointly developed guidelines or other mechanisms.

In the absence of State law governing collaboration, such collaboration is to be evidenced by NPPs documenting the NPP’s scope of practice and indicating the relationships that they have with physicians to deal with issues outside their scope of practice.

The collaborating physician does not need to be present with the NPP when the services are furnished or to make an independent evaluation of each resident who is seen by the NPP.

GUIDANCE §483.30(f) At the option of the State, NPPs in a NF, who are not employees of the facility, may perform physician tasks including performing examinations, evaluations, required visits and writing orders.

If the physician delegates the task of performing visits to the NPP, the NPP must meet all the requirements for

• §483.30(a), F710, physician supervision

• §483.30(b), F711, physician visits

• §483.30(c), F712, physician frequency and timeliness of visits

NOTE: If concerns are identified regarding the NPP meeting the requirements for physician supervision, physician visits or frequency and timeliness of visits, investigate under the corresponding regulation.

Orders written by a NPP who is employed by the NF and are written during visits that are not required visits, and are therefore “other medically necessary visits,” do not require physician co-signature except as mandated by State law.

The following is the VA physician regs, and are in addition to the Federal regs above.

38 CFR § 51.340 Physician and other licensed medical practitioner services.

The State home must provide its residents the primary care necessary to enable them to attain or maintain the highest practicable physical, mental, and psychosocial well-being. When a resident needs care other than the State home is required to provide under this subpart, the State home is responsible to assist the resident to obtain that care. The State home must ensure that a physician personally approves in writing a recommendation that an individual be admitted to a domiciliary.

Each resident must remain at all times under the care of a licensed medical practitioner assigned by the State home. The name of the practitioner will be listed in the resident's medical record. The

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State home must ensure that all of the following conditions in paragraphs (a) through (e) of this section are met:

(a) Supervision of medical practitioners. Any licensed medical practitioner who is not a physician may provide medical care to a resident within the practitioner's scope of practice without physician supervision when permitted by State law.

(b) Availability of medical practitioners. If the resident's assigned licensed medical practitioner is unavailable, another licensed medical practitioner must be available to provide care for that resident.

(c) Visits. The primary care physician or other licensed medical practitioner, for each visit required by paragraph (d) of this section, must

(1) Review the resident's total program of care, including medications and treatments;

(2) Write, sign, and date progress notes; and

(3) Sign and date all orders.

(d) Frequency of visits. The primary care physician or other licensed medical practitioner must conduct an in-person medical assessment of the resident at least once a calendar year, or more frequently based on the resident's condition.

(e) Availability of emergency care. The State home must assist residents in obtaining emergency care.

38 CFR § 51.150 Physician services.

A physician must personally approve in writing a recommendation that an individual be admitted to a facility. Each resident must remain under the care of a physician.

(a) Physician supervision. The facility management must ensure that—

(1) The medical care of each resident is supervised by a primary care physician;

(2) Each resident's medical record lists the name of the resident's primary physician, and

(3) Another physician supervises the medical care of residents when their primary physician is unavailable.

(b) Physician visits. The physician must—

(1) Review the resident's total program of care, including medications and treatments, at each visit required by paragraph (c) of this section;

(2) Write, sign, and date progress notes at each visit; and

(3) Sign and date all orders.

(c) Frequency of physician visits.

(1) The resident must be seen by the primary physician at least once every 30 days for the first 90 days after admission, and at least once every 60 days thereafter, or more frequently based on the condition of the resident.

(2) A physician visit is considered timely if it occurs not later than 10 days after the date the visit was required.

(3) Except as provided in paragraphs (c)(4) of this section, all required physician visits must be made by the physician personally.

(4) At the option of the physician, required visits in the facility after the initial visit may alternate between personal visits by the physician and visits by a physician assistant, nurse practitioner, or clinical nurse specialist in accordance with paragraph (e) of this section.

(d) Availability of physicians for emergency care. The facility management must provide or arrange for the provision of physician services 24 hours a day, 7 days per week, in case of an emergency.

(e) Physician delegation of tasks.

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(1) Except as specified in paragraph (e)(2) of this section, a primary physician may delegate tasks to:

(i) a certified physician assistant or a certified nurse practitioner, or

(ii) a clinical nurse specialist who—

(A) Is acting within the scope of practice as defined by State law; and

(B) Is under the supervision of the physician.

Note to paragraph (e):

An individual with experience in long term care is preferred.

(2) The primary physician may not delegate a task when the regulations specify that the primary physician must perform it personally, or when the delegation is prohibited under State law or by the facility's own policies.

Physicians shall bill RVC monthly for their part of services.

Physicians shall independently bill facility visits made for RVC resident encounters to RVC resident insurances to include Medicare and Medicaid at the then existing Medicare allowable rates for such encounters.

Shall independently bill facility visits made for RVC resident encounters to RVC resident private health insurance carriers to the extent allowable by those carriers.

RVC shall provide all necessary RVC resident information required for billing resident Medicare, Medicaid and/or private insurance carriers. However, RVC shall in no event be held responsible for the collection of any Physician charges billed to RVC residents’ insurances.

RVC will be billed for:

A. Veterans/residents who do not have insurance: Medicare, Medicaid, or other health insurance to bill for provided physician visits.

B. Veterans who have a service connection of 70% - 100% which places them in what RVC refers to as a Mandatory Status and are seen by a contracted physician.

The Medicare Fee Schedule will serve as the fee schedule from which the Physicians will bill RVC.

Services excluded from Medicare consolidated billing will not be paid by RVC.

(NOTE overnight stays and travel are not considered as a part of this RFP)

3.00 Evaluation Criteria

The Kentucky Department of Veterans Affairs/Office of Veterans Centers shall conduct a comprehensive, fair, and impartial evaluation of all proposals. The Kentucky Department of Veterans Affairs/Office of Veterans Centers may reject any proposal that is incomplete or in which there are significant inconsistencies or inaccuracies. The Kentucky Department of Veterans Affairs/Office of Veterans Centers reserves the right to reject all proposals.

The Kentucky Department of Veterans Affairs/Office of Veterans Centers has established a Proposal Evaluation Committee to review, evaluate and verify information submitted by the offeror.

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Each vendor is responsible for submitting all relevant, factual and correct information with their offer to enable the evaluator(s) to afford each vendor the maximum score based on the available data submitted by the vendor.

The Kentucky Department of Veterans Affairs/Office of Veterans Centers shall evaluate the proposals by assigning scores as indicated.

Technical Proposal Evaluation

Criteria Maximum Points Possible Mandatory Requirement

Must submit: Copy of License to practice medicine in the Commonwealth of Kentucky.

Must submit: Copy of DEA license.

Must provide copy of registration with Secretary of State.

Must submit: Certificate of Liability Insurance (must maintain during the life of the contract).

Must provide verification that provider has not been excluded as Medicare/Medicaid Provider.

Requirements that include the words “Shall”, “Will”, “Must” indicate a mandatory requirement

Mandatory Requirement means a condition set out in the specifications or statement of work that must be met without exception.

PROPOSALS THAT DO NOT MEET

MANDATORY REQUIREMENTS WILL BE

DEEM…