P03_JASoleSource_36C255-24-AP-1672_ChaffeeNursingCenter_Redacted2.pdf

John J. Pershing VA Medical Center (VAMC) Nursing Home 36C255 24 AP 1672 Attachment 1: Request for Sole Source Justification Template >SAT $7.5M under FAR13.5

DEPARTMENT OF VETERANS AFFAIRS

SOLE SOURCE JUSTIFICATION UNDER SIMPLIFIED PROCEDURES FOR CERTAIN COMMERCIAL

ITEMS IN ACCORDANCE WITH FAR 13.5

Acquisition Plan Action ID: 36C255 24 AP 1672

Contracting Activity: Department of Veterans Affairs (VA), Veterans Integrated Services Network (VISN) 15, Network Contracting Office 15 (NCO 15), John J. Pershing VA Medical Center (VAMC). This procurement will be funded by a VA Form 1358, Obligation or Change in Obligation.

This procurement is for CHAFFEE NURSING CENTER Nursing Home Services in accordance with FAR 13.5 Simplified Procedures for Certain Commercial Items and specifically FAR 13.501 Special Documentation Requirements, where acquisitions conducted under Simplified Acquisition Procedures are exempt from the requirements of FAR Part 6. The Community Nursing Home (CNH) Services for review shall be awarded as a new contract with a 12 month base period and four (4) 12 month options. This sole source acquisition shall be a fixed price (FP) with economic price adjustment (EPA) multiple year indefinite delivery, indefinite quantity (IDIQ) contract. The estimated value of the proposed action is $4,648,605.42 for a base plus four (4) option years.

Description of Supplies/Services Required to Meet the Agency’s Needs: The proposed action is to award a FP single ID/IQ with EPA with the rates adjusting only to the current published Medicaid rate, with a nursing home facility capable of furnishing the total medical, nursing, and psychosocial needs of VA beneficiaries.

All nursing homes facility(s) must have current Center of Medicare and Medicaid Services (CMS) certification (Medicare and/or Medicaid) and a State nursing home license.

The VA requires CNHs to have bed capacity to ensure their ability to take referrals when requested. The CNH also must be able to accept VA referrals in a timely fashion (ideally within 24 hours of request).

Provider visits must be provided at the rate of one (1) visit per month. Laboratory, x ray, and other special services will be available to VA patients as needed. In addition, the care provided will include room, meals, nursing care, and other services or supplies commensurate with the VA authorized level of care, without extra charge.

The per diem rate(s) established in the ID/IQ shall include the cost of primary medical care, one (1) provider visit per month and needed consultation, a percentage of medications and routine supplies, laboratory, x ray, and other special services authorized by VA, unless otherwise specifically excepted.

Full attention shall be given to motivating and educating patients to achieve and maintain independence in the activities of daily living. Every effort shall be made to keep patients ambulatory and to achieve an optimal level of self care.

Nursing Homes provide a place where Veterans can live full time and receive skilled nursing care any time of day or night. The VA Medical Center contracts with community nursing homes within its vicinity to care for Veterans near their homes and families.

Services that may be required include:

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

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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.

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.

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.

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

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 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):

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.

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.

A notice of intent to sole source in Chaffee, MO was published through SAM.gov on 03/08/2024 and expired on 03/15/2024 with no response from interested vendors. The Intent to Sole Source will remain posted until April 13, 2024. Any responses after expiration will be forwarded to the VAMC CNH Coordinator for further consideration for potential IDIQ or Veterans Care

CHAFFEE NURSING CENTER has been vetted and approved by the John J. Pershing VA Medical Center (VAMC) to perform nursing home services for veterans. Veterans in need of care have been identified in the vicinity of CHAFFEE NURSING CENTER.

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.

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Veteran Small Business Certification (VetCert) 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 procurement instruments available for CNH contracts using search criteria using Product or Service Q402, and all vendor types.

Market research findings includes Veteran Small Business Certification (VetCert), 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:

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.

Chaffee Nursing Center's catchment area in and around Chaffee, MO will serve an estimated veteran population of 10,404 to 12,847 over the next ten years.

Chaffee Nursing Center has a four (4) star overall rating with three (3) star quality: waiver is not required. There are a total of 17 nursing homes and two (2) existing VA CNH contracts within a 25 mile radius of Chaffee, MO.

Medicare.gov provides the most resourceful data for market research filtered by location and Medicare star ratings.

In accordance with VHA Notice 2023 07, Community Nursing Home Program, dated September 05, 2023, 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.

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.

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.

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.

This facility will provide nursing home care for veterans in an underserved area. This is a new requirement identified by the

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Mike Carson Date Contracting Officer Network Contracting Office (NCO) 15

Paula Galvin Date Supervisory Contract Specialist Branch Chief, Healthcare Team Network Contracting Office (NCO) 15

Peggy Becker Date Supervisory Contract Specialist Division Chief, Division I Network Contracting Office (NCO) 15

Andrew J. Raiber, CPCM Date Director of Contracting Network Contracting Office (NCO) 15

Daryl A. Berg Date Executive Director, RPO Central Head of Contracting Activity

c. VHA RPO HCA Review and Approval: I have reviewed the foregoing justification and find it to be complete and accurate to the best of my knowledge and belief and approve ($750K to $7.5 million (or $15.0 million for acquisitions described in FAR 13.500(c)) for other than full and open competition.

a. Contracting Officer or Designee’s Certification (required): I certify that the foregoing justification is accurate and complete to the best of my knowledge and belief.

b. One Level Above the Contracting Officer (Required over SAT but not exceeding $750K): I certify the justification meets requirements for other than full and open competition.

13. Approvals in accordance with the VHAPM Part 806.3 OFOC SOP:

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03/25/2024

PAULA GALVIN Digitally signed by PAULA GALVIN Date: 2024.03.20 10:29:14 -05'00'

MICHAEL CARSON Digitally signed by MICHAEL CARSON Date: 2024.03.20 10:52:26 -05'00'

PEGGY BECKER Digitally signed by PEGGY BECKER Date: 2024.03.20 11:07:51 -05'00'

ANDREW RAIBER

Digitally signed by ANDREW

RAIBER

Date: 2024.03.22 10:12:53 -05'00'

DARYL BERG

Digitally signed by DARYL

BERG

Date: 2024.03.25 12:33:08 -05'00'