_JA_36C255-22-AP-2836_CNH Brunswick NursingRehab_SIGNED1-Redacted.pdf

VHAPG Part 813.5 Simplified Acquisition Procedures for Certain Commercial Items Attachment 1: Request for Sole Source Justification Template >SAT $7.5M under FAR13.5

Extensive Services: Residents satisfying the following two conditions: Having a minimum ADL dependency score of 2 or more. While a resident, receiving complex clinical care and have needs involving: tracheostomy care, ventilator/respirator, and/or infection isolation.

Special Care Low: Residents satisfying the following two conditions: Having a minimum ADL dependency score of 2 or more. Receiving complex clinical care or have serious medical conditions involving any of the following: cerebral palsy with ADL dependency score of 5 or more, multiple sclerosis with ADL dependency score of 5 or more, Parkinson�s disease with ADL dependency score of 5 or more, respiratory failure and oxygen therapy while a resident, tube feeding meeting intake requirement, ulcer treatment with two or more ulcers including venous ulcers, arterial ulcers or Stage II pressure ulcers, ulcer treatment with any Stage III or IV pressure ulcer, foot infections or wounds with application of dressing, radiation therapy while a resident, or dialysis while a resident.

Clinically Complex: Residents receiving complex clinical care or have conditions requiring skilled nursing management, interventions or treatments involving any of the following: pneumonia, hemiplegia with ADL dependency score of 5 or more, surgical wounds or open lesions with treatment, burns, chemotherapy while a resident, oxygen therapy while a resident, IV medications while a resident, or transfusions while a resident.

Behavioral Symptoms and Cognitive Performance: Residents satisfying the following two conditions:

Having a maximum ADL dependency score of 5 or less. Having behavioral or cognitive performance symptoms, involving any of the following: difficulty in repeating words, temporal orientation, or recall (score on the Brief Interview for Mental Status <=9), difficulty in making self understood, short term memory, or decision making (score on the Cognitive Performance Scale >=3), hallucinations, delusions, physical behavioral symptoms toward others, verbal behavioral symptoms toward others, other behavioral symptoms, rejection of care, or wandering.

Special Care High: Residents satisfying the following two conditions: Having a minimum ADL dependency score of 2 or more. Receiving complex clinical care or have serious medical conditions involving any one of the following: comatose, septicemia, diabetes with insulin injections and insulin order changes, quadriplegia with a higher minimum ADL dependence criterion (ADL score of 5 or more), chronic obstructive pulmonary disease (COPD) with shortness of breath when lying flat, fever with pneumonia, vomiting, weight loss, or tube feeding meeting intake requirement, parenteral/IV feeding, or respiratory therapy.

Rehabilitation Plus Extensive Services: Residents satisfying all the following three conditions: Having a minimum activity of daily living (ADL) dependency score of 2 or more. Receiving physical therapy, occupational therapy, and/or speech language pathology services while a resident. While a resident, receiving complex clinical care and have needs involving tracheostomy care, ventilator/respirator, and/or infection isolation.

Rehabilitation: Residents receiving physical therapy, occupational therapy, and/or speech language pathology services while a resident.

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4. Statutory Authority Permitting Restricted Competition:

(X) ( ) International Agreement ( ) Authorized or Required by Statute ( ) National Security ( ) Public Interest

The quality of care for the Veteran is accomplished through placement in a nursing home that is in close proximity to where the Veteran and his/her family resides. Notably, in the VA�s community nursing home program the Veteran�s placement decision is made by the VA clinician(s)/provider(s), the Veteran, and the Veteran�s family. The placement decision will be based on established VA contracts within the catchment area the Veteran resides. The geographic factor in these circumstances makes this requirement unique and, therefore, not subject to competition.

FAR 13.5 Simplified Procedures for Certain Commercial Items. The statutory authority for applying the Simplified Procedures for Commercial Items of FAR 13.5 is 41 U.S.C. § 1901 and is implemented by FAR 13.106 1(b)(2) for restricting competition on this procurement. Competition is restricted on this procurement for the reason below:

Only One Responsible Source and No Other Supplies or Services Will Satisfy Agency Requirements Unusual and Compelling Urgency Industrial Mobilization, Engineering, Developmental or Research Capability or Expert Services

5. Demonstration that the Contractor�s Unique Qualifications or Nature of the Acquisition Requires the Use of the Authority Cited Above (applicability of authority):

As prescribed in VHA Handbook 1143.2, VHA Community Nursing, for more than 35 years the CNH Program has maintained two cornerstones: some level of patient choice in choosing a nursing home close to the Veteran�s home and family, and a unique approach to local oversight of CNHs.

Reduced Physical Function: Residents whose needs are primarily for support with activities of daily living and general supervision. Calculations identify residents who are receiving restorative nursing services as recorded on the MDS and include: urinary and/or bowel training program, passive and/or active range of motion, amputation/prosthesis, training, splint or brace assistance, dressing or grooming training, eating or swallowing training, transfer training, bed mobility and/or walking training, communication training.

In accordance with the FAR 13.5, this sole source Community Nursing Home acquisition shall not exceed $7.5M using simplified procedures.

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VIP Home VetBiz Portal (va.gov) identifies verified capable Service Disabled Veteran Owned Small Business and Veteran Owned Small Business concerns. NAICS 623110, Nursing Care Facilities (Skilled Nursing Facilities) is used as a search criteria with no findings.

Interagency Contract Directory Portal is a Government wide database of contracts and other procurement instruments intended for use by multiple agencies. A search of this databased does not produce other

Market research findings includes VIP Home VetBiz Portal (va.gov), Interagency Contract Directory Portal, Medicare.gov, Veteran Population National Center for Veterans Analysis and Statistics (va.gov) and reviews of recent CNH market research for similar or identical requirements. See below for results:

BRUNSWICK NURSING & REHAB has been vetted and approved by the Harry S. Truman VA Medical Center (VAMC) to perform nursing home services for veterans. Veterans in need of care have been identified in the vicinity of BRUNSWICK NURSING & REHAB.

6. Description of Efforts Made to ensure that offers are solicited from as many potential sources as deemed practicable: A collaborative effort between the Contracting Officer and Program Office includes searches for potential sources for a sole source CNH acquisition. Nursing home services are a commercial service and in house nursing home capabilities at the VAMC is limited to short term post operative and procedure rehabilitation, consistent with that of commercial hospitals. Specialized services are required by nursing homes at a variety of care levels appropriate to individual patient needs. Some VAMC have limited nursing home space available; however, the eligibility requirements for in patient admissions take precedence, hence a waiting list for in house services would exist without contracted facilities being readily available as an essential resource.

The VAMC projected nursing home eligible patient population has projected growth annually based on patient aging, eligibility, and health demographics.

7. Determination by the CO that the Anticipated Cost to the Government will be Fair and Reasonable: The CO anticipates the overall cost will be considered fair and reasonable. The CO will negotiate nursing home rates consistent with the current Centers for Medicare and Medicaid Services (CMS) rates. The CO shall utilize the Resource Utilization Groups (RUGs) IV classification system of categories and codes to reference the required levels of care for veterans in the facility. The VA Base rate will be applied to all levels of care. This is based on most recent data on the national average of VA versus Medicaid reimbursement, and the both average Medicaid and VA CNH residents being rated �Reduced Physical Function� or �Behavioral or Impaired Cognition Performance�. The remaining VA CNH residents� RUG IV ratings have a negotiable maximum percentage range (multiplier). The CO shall negotiate within the allowable range.

8. Description of the Market Research Conducted and the Results, or a Statement of the Reasons Market Research Was Not Conducted: According to 38 USC 8153, Sharing of health care resources, the rule of two does not apply to sole source awards. However, the contracting officer shall consider the impact and determine the best method of successfully implementing the rule of two requirement according to the Veterans First Contracting Program. Although there are several factors that support the sole source decision, one critical factor in the initial placement effort combined with the medical need and availability of the nursing home facility, is the Veteran�s choice in a nursing home facility is based on proximity to family and home.

A notice of intent to sole source in Brunswick, MO was published through SAM.gov on 06/09/2022 and expired on 06/16/2022 with no response from interested vendors.

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New CNH opportunities will be sought based on program office expressed bona fide need as it arises.

procurement instruments available for CNH contracts using search criteria using Product or Service Q402, and all vendor types.

Medicare.gov provides the most resourceful data for market research filtered by location and Medicare star ratings. In accordance with VHA Notice 2020 32, Community Nursing Home Program, dated Oct 1, 2020, nursing homes are expected to have either a three star overall rating or a two star overall rating with a four star or greater quality measure scores on the Centers for Medicare and Medicaid (CMS) Nursing Home Compare website. It is recognized that the use of CNHs that do not meet eligibility without a waiver may be necessary due to resident population or geographic considerations. When required, waivers will be prepared by the VAMC and will be signed and approved by both the VAMC Director and VISN Director.

9. Any Other Facts Supporting the Use of Other than Full and Open Competition: Under the authority of 38 USC 8153 implemented in VAAR 873, it is the Contracting Officer's (CO) determination to award a sole source single IDIQ contract for CNH services not to exceed $7.5 M using simplified procedures using FAR Part 13.5.

Acquisition shall be conducted using the acquisition strategies at VAAR 873.111(a) Request for Quotations, and VAAR 873.111(d)(1)(i) Alternative Negotiation Techniques, in conjunction with FAR Part 13.

Brunswick Nursing & Rehab's catchment area in and around Brunswick, MO will serve an estimated veteran population of 4,207 to 6,012 over the next ten years.

Brunswick Nursing & Rehab has a four (4) star overall rating with two (2) star quality: waiver is not required.

There are a total of 9 nursing homes and zero (0) existing VA CNH contracts within a 25 mile radius of Brunswick, MO.

Veteran Population National Center for Veterans Analysis and Statistics (va.gov) provides Veteran populations by county and state with a timeline projection of 30 years. This data verifies the facility�s needs and supports justification for contracted nursing homes.

10. Listing of Sources that Expressed, in Writing, an Interest in the Acquisition: Based on any responses from interested parties with the notice of intent to sole source, consideration may be given to eligible nursing homes.

11. A Statement of the Actions, if any, the Agency May Take to Remove or Overcome any Barriers to Competition before Making subsequent acquisitions for the supplies or services required: There are no barriers as CNH�s are sole sourced based on VA Medical Center needs for Veterans in catchment areas so long as interested CNH�s meet the qualifications and oversight requirements stated in VHA Notice 2020 32, Community Nursing Home Program, dated Oct 1, 2020.

For the health and well being of the veteran, the Veteran and their family have a choice in nursing home placements. Veteran preference is the determining factor in patient placements and only the selected nursing home may be considered.

Brunswick Nursing & Rehab's current BOA expires on July 31, 2022. It is not the intent of the program office or the contracting office to procure a new facility when there are currently 7 veterans already placed at this location. Placing these Veterans in a new facility would not only be a physical, but mental hardship on the Veteran and their family.

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