PWS Hawaii CNHs - Copy.docx

B.4 PERFORMANCE WORK STATEMENT

1. Federal Acquisition Regulation (FAR) – Indefinite Delivery Indefinite Quantity Contract (ID/IQ). In accordance with FAR 16.504, Indefinite Delivery Indefinite Quantity Contracts, this is an ID/IQ from the “Award Date” for five (5)-year ordering periods to renew and to be exercised at the sole discretion of the Government.

2. Services Rendered at VA Per Diem Rates. Upon acceptance of a VA patient by the CNH, if and when requested by the VA Contracting Officer or authorized representative, the Contractor shall furnish all supplies and services herein described, at the per diem rates for the “Levels of Care” specified in the Schedule of Items of this ID/IQ. The VA “Levels of Care” are defined in an attachment in Section D.1 of the solicitation and the ID/IQ. VA is obligated only to the extent authorized placement of patients is made in accordance with this ID/IQ.

3. Background/Introduction. The Community Nursing Home (CNH) program is a key component of the Veterans Health Administration (VHA) continuum of care. The Contractor agrees to provide in accordance with the terms and conditions stated herein to the U.S. Department of Veterans Affairs Pacific Islands Health Care System (VAPIHCS), in Hawaii at the prices specified in the section titled Schedule of Items of this ID/IQ. Nursing home facilities shall accept Veterans of which they have the capability/capacity to care. The term, “facilities,” shall include but not be limited to rooms, wards, sections, eating areas, drinking fountains, entrances, and other like areas. VA shall have the right to assess the CNH and all appurtenances by authorized VA representative(s) to ensure that acceptable standards are maintained and that the necessary care to maintain the well-being of the patient is rendered.

4. Requirements. Nursing home facilities in the CNH program shall ensure that care meets the health needs and promotes the maximum well-being of VA beneficiaries. Nursing home care will be furnished based on an interdisciplinary assessment to ensure the total medical, nursing, and psychosocial needs of VA beneficiaries are being met. Full attention shall be given to motivating and educating patients to achieve and maintain independence in the activities of daily living, to the maximum extent possible. Every effort shall be made to keep Veterans ambulatory, while achieving an optimal level of self-care and to coordinate discharge arrangements when clinically appropriate.

4.1. All nursing home facilities in VA’s CNH program must have the following:

4.1.1. Current Center for Medicare and Medicaid Services (CMS) certification (Medicare and/or Medicaid) and a State nursing home license.

4.1.2. Current and unrestricted State/Federal nursing home licensure and certification.

4.1.3. Liability insurance and must be maintained and available for review.

4.2. VA developed quality of care standards utilizing CMS inspection criteria that are followed by VA in its selection of nursing homes which includes exclusionary criteria on which the CNH is evaluated. See VHA Notice 2020-32 “Community Nursing Home Program”, VHA Handbook 1143.2, “VHA Community Nursing Home Oversight Procedures (June 4, 2004) a copy of which is available at:

http://www.va.gov/vhapublications/publications.cfm?pub=2.

4.3. VA CNH Program often has a particular need for specialty level of care services. The VA requires CNHs to have bed capacity and capability to accept VA authorized Veterans in a timely fashion (ideally within 24 hours of request).

4.4. Provider visits will be available at the rate of one (1) visit per month; other services such as laboratory, x-ray, and other special services will be available to VA patients as needed. Additionally, inclusive authorization of care provided without extra charge will include the following: room, medications, meals, nursing care, provider visits as needed and other services/supplies commensurate with the VA-authorized level of care, as specified in the Schedule of Items of this ID/IQ.

4.5. Duly authorized representatives of VA will conduct visits to the CNH in order to provide continuity of care and quality oversight VA placed Veterans and to assist in the Veterans’ transition back into the community. These visits do not substitute nor alleviate the CNH’s contracted responsibility for the daily care and medical treatment of the Veteran.

4.6. The per diem rate(s) established in this ID/IQ will include the cost of primary medical care, at a minimum one (1) provider visit per month (including needed consultation, medications and routine supplies, laboratory, x-ray, and other VA authorized specialty services, unless otherwise and specifically excluded). See the Schedule of Items for details regarding the per diem rates, inclusions and exclusions. Every effort will be made to help patients achieve and maintain the highest possible quality of life. CNH staff shall direct their full attention to keeping the patients’ ambulatory as well as educating and motivating patients to achieve and maintain independence in the activities of daily living (ADL) as well as the optimal level of self-care.

5. Termination of Services. VA reserves the right to remove any or all VA patients from the CNH at any time when it is determined to be in the best interest of VA or the patients without additional costs to the Government or the Veteran.

6. VA Authorizations. Authorization for nursing home care will be submitted on VA Form 10-7078, “Authorization and Invoice for Medical and Hospital Services.” Each authorization validity period will be noted on the VA Form 10-7078 with a beginning and end date. Any extension to the original authorization validity period, regardless of the number of days, requires a new VA Form 10-7078 must be received prior to services being rendered.

7. Medicaid-Based Rates. The current State Medicaid rates may be used as a basis for determination of VA rates. The VA rate will include medical care, routine medications, laboratory, x-ray, therapy (ies), and other special services authorized by VA, unless otherwise specifically exempted. VA will contract for appropriate Medicaid categories of care using Resource Utilization Groups (RUG-IV) as a guide. As with Medicare, a description of the RUG-IV systems can be found in 42 CFR Parts 409, et al.

8. Primary Medical Coverage. The assigned CNH provider is the primary medical provider during the nursing home stay and is responsible for writing or approving admission and all other orders as soon as the Veteran arrives at the CNH. The CNH provider is responsible for general medical care, urgent evaluation and intervention. Provider visits will be according to the Center for Medicare and Medicaid Services (CMS) guidelines. The assigned nursing home provider will provide timely care following the most current CMS guidelines; arranging 24/7 access for patient care; arranging easy access to VA staff for consultation; providing timely response to calls and arranging for timely provider back-up according to OBRA guidelines (42 CFR 483.40, OBRA Guidelines).

9. Rehabilitation Criteria. All therapy provided under this ID/IQ will be individual therapy, rather than group therapy, unless otherwise ordered by the authorizing VA facility. Therapy will require pre-approval by VA before services are provided. Medical Restorative criteria will be used for physical therapy, occupational therapy, and speech therapy. Therapy must be skilled, relate to safety and be restorative according to Medicare criteria.

9.1. Description of Rehabilitative Therapy. The concept of rehabilitative therapy includes recovery or improvement in function and, when possible, restoration to a previous level of health and well-being. Therefore, evaluation, re-evaluation and assessment documented in the Progress Report should describe objective measurements which, when compared, show improvements in function, or decrease in severity, or justification for an optimistic outlook to justify continued treatment. Covered therapy services shall be rehabilitative therapy services unless they meet the criteria for maintenance therapy requiring the skills of a therapist.

9.2. Evaluations/re-evaluations should consider the following: Establishment of treatment goals specific to the patient’s disability or dysfunction and designed to specifically address each problem identified in the evaluation; design of a plan of care addressing the patient’s disorder, including establishment of procedures to obtain goals, determining the frequency and intensity of treatment; continued assessment and analysis during implementation of the services at regular intervals; instruction leading to establishment of compensatory skills; selection of devices to replace or augment a function (e.g., for use as an alternative communication system and short-term training on use of the device or system); and patient and family training to augment rehabilitative treatment or establish a maintenance program. Education of staff and family should be ongoing.

10. Emergency Care; Financial Responsibility; Advanced Directives. In emergencies, nursing home staff will utilize the 911 local emergency systems as for any resident. Advance directives or living wills shall be adhered to according to CNH physician’s orders. When private hospitalization or emergency services are required, the patient, spouse, financial guardian or insurer may be financially responsible. Service-connected Veterans may qualify for VA coverage of emergency care provided the VA Health Care System (VAHCS) is contacted by the private hospital provider within 72-hours of admission on the first business day following a weekend or holiday. This includes the cost of necessary transportation for such care.

11. HIPAA Compliance. HIPAA compliance is required. The Contractor shall adhere to the provisions of Public Law 104-191, Health Insurance Portability and Accountability Act (HIPAA) of 1996 and the National Standards to Protect the Privacy and Security of Protected Health Information (PHI). As required by HIPAA, the Department of Health and Human Services (HHS) has promulgated rules governing the security and use and disclosure of protected health information by covered entities, including the Department of Veterans Affairs (VA). In accordance with HIPAA, the Contractor may be required to enter into a Business Associate Agreement (BAA) with VA, but VACO has recognized CNH facilities as an entity that does not require a BAA as long as they are conducting health care on VA’s behalf. The CNH care program qualifies as a medical service, so no BAA is required.

12. State Licensure; Access to CNH Quality of Care Reports (QASP Indicator #1). The CNH must maintain a current and unrestricted state license to operate as a skilled nursing facility. Changes in the status of the licensure will be immediately reported to the VAPIHCS CNH Program Coordinator at 808-433-0221. VA will monitor the professional care and administrative management of services provided to VA beneficiaries under this ID/IQ, through one or any combination of the following methods: reviews of State agencies reports; on-site inspection of the CNH by VA staff; and/or on-site monitoring of VA patients. The CNH shall provide VA with copies of all State agency reports when requested and cooperate fully with VA’s quality improvement or quality assurance program functions relating to this ID/IQ, including VA’s on-site inspection and monitoring. The VA Contracting Officer shall make all final determinations as to the Contractor’s reasonable cooperation with VA and compliance with these requirements.

13. Corrective Action Plan (QASP Indicator #2). The CNH will cooperate with timely development of Corrective Action Plans (CAPs) related to identified deficiencies and related to State, Federal or VA surveys. The CNH will develop in the time period specified by VA timely and appropriate CAPs for VA surveys or investigation of complaints related to quality of care or sentinel events. The CNH will also supply related documents or data as specified by VA. The CAPs will include but are not limited to the following criteria and shall:

13.1. Contain elements detailing how the CNH will correct the deficiency as it relates to the individual;

13.2. Indicate how the CNH will act to protect residents in similar situations;

13.3. Include the measures the CNH will take or systems that will be altered to ensure that the problem will not recur. The CNH must look at the system and determine if a change to the existing system will work, if a new system is necessary, or if a system does not exist and must be developed;

13.4. Indicate how the CNH plans to monitor performance to make sure that solutions are permanent. The CNH must develop a quality assurance tool for ensuring that correction is achieved and sustained. This tool must be implemented. Failure to implement a quality assurance tool to sustain compliance will reflect that the CNH has an ineffective quality assurance system; and

13.5. Provide dates when corrective action will be completed.

14. Life Safety Code. The CNH’s building shall conform to the most recent standards of the Life Safety Code (National Fire Protection Association Standard #101) in effect on the date of the ID/IQ award and compliance with all applicable Federal, State and local regulations. The administrator of the CNH is required to notify the VA Contracting Officer in writing at least thirty (30) calendar days prior to any planned facility changes that could impact the Life Safety Code and other safety features of the facility which were in existence at the time this ID/IQ became effective. The VA Contracting Officer will notify the VA Safety Manager responsible for the Life Safety Code inspection of the CNH and he/she will review (inspect the facility if required) the proposed changes and provide necessary approval or disapproval of the CNH to house Veterans during and/or after the proposed changes. These changes may include but are not limited to:

14.1. Interior changes requiring VA approval. Some examples of facility changes that require the VA Contracting Officer notification are as follows: interior finish, corridor partitions/walls, patient room doors, linen or trash chutes, exits, emergency lighting, fire alarm systems, automatic sprinklers, smoke barrier walls or doors, oxygen systems, compressed gas storage, HVAC, electrical and fuel gas systems;

14.2. Automatic sprinkler system. All VA contracted CNH facilities are to be fully-equipped with a fully-automatic sprinkler system installed in accordance with the National Fire Protection Association’s (NFPA) standards and be 100% sprinklered;

14.3. Natural disasters. In the event of a natural disaster (flood, tornado, fire, earthquake, etc.), the CNH shall communicate all action plans to VA. The action plans will at a minimum identify temporary transfers of location, dates, and names of Veterans transferred; and

14.4. Major construction; additions; and renovations. Major construction including building additions or other renovations which may affect physical plant integrity; SHALL MEET latest NFPA 101 Life/Safety Code requirements as well as any additional VA CNH construction standards in place at time of renovation or alteration.

15. Acceptable Safety and Sanitation Practices. Acceptable safety and sanitation practices shall be observed throughout the facility. The CNH will address employee and patient safety practices through staff orientation, training and adherence to related policy or procedures to provide a safe and clean environment.

16. Re-admission to the VA Hospital and Emergency Care; Notification of Death of Veterans; CNH Responsibility to Veteran’s Belongings or Personal Effects (QASP Indicator #3). VA beneficiaries who begin to require more than the level of care authorized by VA will be readmitted to an appropriate VA facility, as determined and authorized by VA.

16.1. When such an admission is not feasible because of the nature of the emergency, hospitalization in a non-Federal facility may be accomplished provided VA authorization is obtained. VA authorization must be obtained within 72-ours of admission of the patient to a non-Federal facility and notice of any Veteran death within 24-hours or immediately the first business day after a weekend or holiday.

16.2. In the event of a death of any Veteran, the Contractor shall notify the VA immediately of the death. In the event a death of a VA beneficiary while receiving nursing home care under this ID/IQ, the CNH shall promptly notify the VA facility which authorized admission and immediately assemble, inventory, and safeguard the patient’s personal effects. The funds, deposits, and effects left by the VA patients upon the premises of the CNH shall be delivered by the CNH to the person(s) entitled thereto under the laws currently governing the CNH for making disposition of funds and effects left by patients, unless the beneficiary died without leaving a will, heirs or next of kin capable of inheriting.

16.3. When disposition has been made, the itemized inventory with annotation as to the disposition of the funds and effects will be immediately forwarded to the VA facility authorizing admission. Should a deceased patient leave no will, heirs, or next of kin, his/her personal property and funds wherever located vests in and becomes the property of the United States in trust. In these cases, the CNH shall forward an inventory of any such property and funds in its possession to the VA facility authorizing admission and will hold them (except articles of clothing necessary for proper burial) under safeguard until instructions are received from VA concerning disposition. CMS regulations require retention of records for five (5) years when there is no requirement in State law.

17. Leave of Absence (LOA) – Bed-Hold Statement. For re-hospitalizations or therapeutic passes, VA will pay a bed hold. Therapeutic passes will be authorized by the CNH Coordinators based on individual patient needs but are generally limited to two (2) times per month and should be pre-approved. VA will cover bed holds based on the following plan:

17.1. The number of covered bed-hold days shall be determined by the CNH Coordinators on a case-by-case basis.

17.2. Bed-hold will begin the date the resident leaves the CNH and full per diem will resume on the date of readmission to the CNH.

18. Reportable Events (QASP Indicator #4). VA requires CNHs to report to the CNH Coordinator at VA any of the following events within 24-hours or immediately the first business day after a weekend or holiday:

18.1. Sentinel events;

18.1.1. When there is a change of ownership of the CNH;

18.1.2. When there is a change of nursing home administrator or Director of Nursing/Director of Nursing Service;

18.1.3. substantiated allegations of mistreatment, neglect, abuse or misappropriation of CNH Veterans or property;

18.1.4. Elopements of CNH Veterans pursuant to state regulations;

18.1.5. Infectious outbreaks;

18.1.6. Resident to resident or resident to staff altercations involving a CNH Veteran resulting in any injury that is other than minor;

18.1.7. Copies of annual surveys or substantiated complaint investigations conducted by a State oversight agency; and

18.1.8. Adverse events. Reporting shall include date of occurrence and patient disposition and outcome.

18.2. A sentinel event may include, but is not limited to the following:

18.2.1. A fall resulting in death or injury;

18.2.2. Elopement resulting in a missing patient;

18.2.3. Patient abuse confirmed or under suspicion;

18.2.4. A medication error resulting in patient illness or injury;

18.2.5. Death or patient injury related to restraint (including side rails) use; or

18.2.6. Death related to an unconfirmed or suspicious cause.

18.3. When an adverse event occurs involving a CNH Veteran which is not determined to be a Sentinel Event (but that the State requires that the occurrence be reported to the State), such event is also to be reported to VA’s CNH program office. Some adverse events, such as minor medication errors without catastrophic outcomes, are managed by the CNH in the context of their quality improvement programs. It is not necessary for nursing homes to report such incidents to the CNH program office.

19. VA Actions Regarding Serious Quality of Care Deficiencies. In cases of serious deficiencies affecting the health or safety of Veterans or in cases of continued uncorrected deficiencies, VA will take one or more of the following actions in accordance with the terms and clauses of the ID/IQ and applicable procurement regulations:

19.1. Increase VA staffing monitoring until the State survey agency clears the deficiency;

19.2. Suspend placement of Veterans in the CNH;

19.3. Remove or transfer Veterans under the ID/IQ from the subject CNH;

19.4. Not renew the ID/IQ; and/or

19.5. Terminate the ID/IQ.

20. VA Staff Access to CNH Records (QASP Indicator #5). All medical records concerning the Veteran’s care in the CNH shall be readily accessible to VA. Upon discharge or the death of a patient, medical records will be retained by the CNH for a period of at least five (5) years following termination of care. Patient records will be maintained in conformance with the Privacy Act of 1974 (5 U.S.C. § 552a). A medical record shall be maintained for each patient, which includes at least the following:

20.1. Sufficient information to identify the resident;

20.2. A record of the Veteran’s assessments, including those assessments performed by services under the ID/IQ with the CNH;

20.3. The plan of care and services including medication administration, provided by CNH staff and services provided under the ID/IQ with the CNH;

20.4. Interdisciplinary progress notes to include effect of care provided, Veterans’ response to treatment, change in condition, and changes in treatment;

20.5. Medical practitioner orders which are signed and dated;

20.6. Allergies;

20.7. Person to contact in an emergency situation;

20.8. Name of attending medical practitioner; and

20.9. Advanced directives if available.

21. VAPIHCS Authorization to the CNH:

Authorization Agreements (VA 10-7078) will be forwarded to the facility.

22. Nursing Home Clinical Record: The CNH shall maintain clinical records on each Veteran in accordance with accepted professional standards and practice. The clinical record must be: complete, accurately documented, readily accessible, systematically organized, and legible. Clinical records must contain at a minimum:

22.1. Sufficient information to identify the resident;

22.2. A record of the Veteran’s assessments, including those assessments performed by services under the ID/IQ with the CNH;

22.3. The plan of care and services including medication administration, provided by CNH staff and services provided under the ID/IQ with the CNH;

22.4. Interdisciplinary progress notes to include effect of care provided, Veterans’ response to treatment, change in condition, and changes in treatment;

22.5. Medical practitioner orders which are signed and dated;

22.6. Allergies;

22.7. Person to contact in an emergency situation;

22.8. Name of attending medical practitioner; and

22.9. Advanced directives if available.

23. Clinical Record Safeguards: The CNH shall safeguard clinical record information against loss, destruction, or unauthorized use. If the CNH maintains a Veteran’s record by computer, electronic signatures are acceptable. If attestation is done on computer records, safeguards to prevent unauthorized access and to provide for reconstruction of information must be in place.

24. Specialty Services: CNH is required to arrange VA specialty clinic appointments when consults or treatment are needed, or in cases where patients who are medically unable to travel to a VA medical center or clinic, CNH will request pre-authorization for non-VA treatment in the local community.

25. 1.1 patient supervision: Is not considered part of routine nursing home care. This service must be pre-authorized. It is the nursing home’s responsibility to allocate the human resource to perform this service. The VA is not responsible for arranging or providing the staff to perform this duty. Pre-authorization for 1:1 patient supervision reimbursement is only provided when the patient presents as an increased safety concern due to increased medical/cognitive/psychiatric acuity. The nursing home is responsible for submitting the request for 1:1 supervision in writing along with clinical justification/documentation indicating the patient’s presenting symptomology. The request must include the hours being requested and note the frequency and length of time the service will be required (i.e., during waking hours only, 12/24 hours for 3 weeks) along with a plan of care to manage the presenting symptoms. An itemized bill must be submitted with claims in order to receive reimbursement.

26. Respite Care: The purpose of this level of care is to provide temporary relief to the primary care giver to help the Veteran to continue reside in their primary residence for as long as possible. It is designed to accommodate Veterans with minimum care needs. Patients with more complex care needs may not be appropriate for this level of care. Inpatient CNH respite reimbursement is provided at the VA’s discretion and must be pre-approved by a VA authorized official.

27. CNH Hospice Coverage: Reimbursement for inpatient CNH hospice care requires pre-authorization. Approval will only be considered for established VA patients who meet hospice clinical criteria, are enrolled in hospice services, and in conjunction with VA provider review and concurrence. This level of coverage is limited to a 6-month period of time after which additional VA Provider review and re-certification will be required for additional coverage approval. It is the responsibility of the CNH facility to request coverage extensions beyond the initial 6-months.

27.1. It is also the responsibility of the CNH facility to notify the designated VA official of any patient hospice care disenrollment.

27.1.1. A grace period of up to 30-days maximum will be provided for patients who no longer desire hospice care or meet hospice criteria to aid in their transition home or to apply for additional/alternative coverage.

27.1.2. Rehabilitation therapy or other ancillary services for restorative purposes will not be approved while patient is under hospice coverage.

28. VA Health Care System Consultation/Resources.

28.1 For non-emergency medical consultation call the VAPIHCS CNH program at 808-433-0221.

28.2 Transportation: Necessary transportation to and from VA authorized appointments will be arranged and paid by the VA for CNH patients when requested. Call VAPIHCS CNH program.

29 Charitable Contributions. The CNH will not solicit contributions, donations, or gifts from patients or family members. Note: Established charitable fundraising activities of a CNH fall outside the scope of this language.

30 CNH Billing (QASP Indicator #6). Invoices for nursing care and ancillary services shall be submitted promptly to the authorizing facility by the 15th calendar day following the end of the month in which services were rendered. The CNH shall promptly notify the VA CNH Coordinator or VA authorized representative regarding any change in Veteran status: discharge, transfer, against medical advice (AMA), hospitalization, death and/or any changes in payer source and any ability to complete timely billing. All provider invoices must accurately reflect the full name and address of the CNH and shall reflect the patient’s name, social security number, number of days billed, authorized/approved RUG category(ies), and level of care provided/established greed upon RUG rate (s). Failure to include this information may result in delayed payment. NOTE: All invoiced services must receive prior VA authorization.

30.1 Pre-approves services billed by CMS procedures or CPT codes: All VA pre-approved services, which are provided in addition to the all-inclusive per diem rate must be billed according to CMS procedures or CPT codes. The CNH will be reimbursed based on local guidelines and VA pricing schedules as authorized by the VA.

30.2 Medications: All Medications administered to VA-contracted Veterans residing in a CNH will be charged at the Average Wholesale Price (AWP) or according to the pharmacy bill, whichever is less. Medication costs up to 8.5% of billed care are included in the RUG rate pricing, Medication costs which exceed 8.5% of the monthly per diem will be billed as a separate line item in addition to the applicable RUG rate(s). All calculations will be made on a monthly basis. When a patient’s medication costs are determined to be in excess of the 8.5%, the VA must be promptly alerted to establish an appropriate course of action. This course of action may include the VA providing medication(s) to the CNH for the contracted Veteran or requiring an acceptable alternative medication be substituted. If for any reason the VA provides patient medications, the rate of reimbursement will be decreased by an agreed upon amount. The VA also reserves the right to deny payment for medication, which at its sole discretion, is determined by the VA to be of no clinical benefit to the Veteran.

30.3 Invoices: Invoices shall be sent on the CMS-1450 (red invoice). The invoices must include the same information as provided to Medicare. Payment will be made monthly, thirty (30) days in arrears, following receipt of a properly prepared invoice. A properly prepared invoice shall include the RUG level and assessment reference date. All Services provided must be itemized (listed separately) on the invoice. Separate invoices will be submitted for each Veteran approved for services under this agreement.

30.4 Any and all corrections to the invoice must be submitted for payment of any authorized ancillary costs or changes to the original invoice. All corrected invoices must include previously approved items that are affected by the correction and should be resubmitted.

31 Minimum Quantities; VA Payment. It is impossible to determine the exact or estimated amount, which will be expended under this ID/IQ. No obligation will be incurred by VA under this ID/IQ, until authorizations are issued for nursing home care of specific beneficiaries. VA agrees to make payment on a timely basis for services rendered in accordance with such authorizations upon receipt of proper invoices submitted by the CNH as outlined in this ID/IQ. VA will make payment for the day a recipient enters the CNH but not the day the recipient leaves a CNH unless entrance and departure are on the same day, then payment will be made for one (1) day.

32 VA Payments. Payments made by VA under any contract pursuant to this ID/IQ, constitute the total cost of nursing home care. No additional charges will be billed to Medicare (with the exception of dialysis and hospice), Medicaid, or private insurance, the beneficiary or his/her family, either by the CNH or any third-party furnishing services or supplies required for such care, unless and until specific prior authorization in writing is obtained from the VA facility authorizing placement. The patient, family and any other entitlement programs (e.g., Medicare, Medicaid, etc.) will not be billed for uncovered services or costs during the VA contract period. This constitutes double-billing and Federal fraud.

32.1 Vendors who bill electronically using the HIPAA-compliant claims transactions must submit claims through the VA clearinghouse, Emdeon, using payer ID number 12115 for medical claims.

32.2 Vendors who are not able to use the HIPAA-compliant transactions are not required to do so. Supporting information for monthly invoices will be mailed or faxed to:

32.2.1 For patients authorized by the VA Hawaii Health Care System, the Government Invoice Address is:

Department of Veterans Affairs VA Hawaii Health Care System Attn: Community Nursing Home Program Center for Aging 459 Patterson Road Honolulu, HI 96819 Fax: (808) 433-0281

End of PWS