RFQ 36C25625Q0095 CNH .pdf

PAGE 1 OF 1. REQUISITION NO.

2. CONTRACT NO. 3. AWARD/EFFECTIVE DATE 4. ORDER NO. 5. SOLICITATION NUMBER 6. SOLICITATION ISSUE DATE

a. NAME b. TELEPHONE NO. (No Collect Calls) 8. OFFER DUE DATE/LOCAL

TIME

9. ISSUED BY CODE 10. THIS ACQUISITION IS UNRESTRICTED OR SET ASIDE: % FOR:

SMALL BUSINESS

HUBZONE SMALL

BUSINESS

SERVICE-DISABLED

VETERAN-OWNED

SMALL BUSINESS

WOMEN-OWNED SMALL BUSINESS

(WOSB) ELIGIBLE UNDER THE WOMEN-OWNED

SMALL BUSINESS PROGRAM

EDWOSB

8(A)

NAICS:

SIZE STANDARD:

11. DELIVERY FOR FOB DESTINA-

TION UNLESS BLOCK IS

MARKED

SEE SCHEDULE

12. DISCOUNT TERMS

13a. THIS CONTRACT IS A

RATED ORDER UNDER

DPAS (15 CFR 700)

13b. RATING

14. METHOD OF SOLICITATION

RFQ IFB RFP

15. DELIVER TO CODE 16. ADMINISTERED BY CODE

17a. CONTRACTOR/OFFEROR CODE FACILITY CODE 18a. PAYMENT WILL BE MADE BY CODE

TELEPHONE NO. UEI: EFT:

PHONE: FAX:

17b. CHECK IF REMITTANCE IS DIFFERENT AND PUT SUCH ADDRESS IN OFFER

18b. SUBMIT INVOICES TO ADDRESS SHOWN IN BLOCK 18a UNLESS BLOCK BELOW IS CHECKED

SEE ADDENDUM

19. 20. 21. 22. 23. 24.

ITEM NO. SCHEDULE OF SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT

(Use Reverse and/or Attach Additional Sheets as Necessary)

25. ACCOUNTING AND APPROPRIATION DATA 26. TOTAL AWARD AMOUNT (For Govt. Use Only)

27a. SOLICITATION INCORPORATES BY REFERENCE FAR 52.212-1, 52.212-4. FAR 52.212-3 AND 52.212-5 ARE ATTACHED. ADDENDA ARE ARE NOT ATTACHED.

27b. CONTRACT/PURCHASE ORDER INCORPORATES BY REFERENCE FAR 52.212-4. FAR 52.212-5 IS ATTACHED. ADDENDA ARE ARE NOT ATTACHED

28. CONTRACTOR IS REQUIRED TO SIGN THIS DOCUMENT AND RETURN _______________ 29. AWARD OF CONTRACT: REF. ___________________________________ OFFER

COPIES TO ISSUING OFFICE. CONTRACTOR AGREES TO FURNISH AND DATED ________________________________. YOUR OFFER ON SOLICITATION

DELIVER ALL ITEMS SET FORTH OR OTHERWISE IDENTIFIED ABOVE AND ON ANY (BLOCK 5), INCLUDING ANY ADDITIONS OR CHANGES WHICH ARE

ADDITIONAL SHEETS SUBJECT TO THE TERMS AND CONDITIONS SPECIFIED SET FORTH HEREIN IS ACCEPTED AS TO ITEMS:

30a. SIGNATURE OF OFFEROR/CONTRACTOR 31a. UNITED STATES OF AMERICA (SIGNATURE OF CONTRACTING OFFICER)

30b. NAME AND TITLE OF SIGNER (TYPE OR PRINT) 30c. DATE SIGNED 31b. NAME OF CONTRACTING OFFICER (TYPE OR PRINT) 31c. DATE SIGNED

AUTHORIZED FOR LOCAL REPRODUCTION (REV. NOV 2021)

PREVIOUS EDITION IS NOT USABLE Prescribed by GSA - FAR (48 CFR) 53.212

7. FOR SOLICITATION

INFORMATION CALL:

STANDARD FORM 1449

SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL PRODUCTS AND COMMERCIAL SERVICES

OFFEROR TO COMPLETE BLOCKS 12, 17, 23, 24, & 30

36C25625Q0095 01-24-2025

Sheliah Saunders, Contract Specialist 713.799.0721 02-11-2025

3:00 PM CST

Department of Veterans Affairs

Network Contracting Office 16

5075 Westheimer Road, Suite 750

Houston TX 77056-5643

X

623110

$34 Million

N/A

36C598

Department of Veterans Affairs

Central Arkansas Veterans HCS

2200 Fort Roots Drive, Building 41

Room 200 (90C/NLR)

North Little Rock AR 72114-1706

36C256

Department of Veterans Affairs

Network Contracting Office 16

5075 Westheimer Road, Suite 750

FSC e-Invoice Payment http://www.fsc.va.gov/fsc/einvoice.asp

Invoice Setup Information 1-877-489-6135

Invoice must be submitted electronically

Contractor to provide Community Nursing Home (CNH) Services for the Department of Veterans Affairs (VA) Central Arkansas

Healthcare System (CAVHS) within Lonoke County.

For additional information reference Schedule of

Services/Performance Work Statement on pages 8 through 21.

For solicitation submission requirements and evaluation factors for this solicitation reference page 55 and page 67.

The following Wage Determinations apply:

2015-5117 REV 26 dated 12/23/2024

Stephanie Keo

VA-VHA-RPOC-2023-0081

36C25625Q0324

Table of Contents

SECTION A

A.1 SF 1449 SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL PRODUCTS

AND COMMERCIAL SERVICES

SECTION B - CONTINUATION OF SF 1449 BLOCKS

B.1 CONTRACT ADMINISTRATION DATA

B.2 PRICE/COST SCHEDULE OF SERVICES

B.3 PERFORMANCE WORK STATEMENT (PWS)

B.4 IT CONTRACT SECURITY

B.5 MANDATORY WRITTEN DISCLOSURES

SECTION C - CONTRACT CLAUSES

C.1 52.212-4 CONTRACT TERMS AND CONDITIONS—COMMERCIAL PRODUCTS

AND COMMERCIAL SERVICES (NOV 2023)

C.2 52.252-2 CLAUSES INCORPORATED BY REFERENCE (FEB 1998)

C.3 52.216-18 ORDERING (AUG 2020)

C.4 52.216-19 ORDER LIMITATIONS (OCT 1995)

C.5 52.216-22 INDEFINITE QUANTITY (OCT 1995)

C.6 52.217-8 OPTION TO EXTEND SERVICES (NOV 1999)

C.7 52.232-19 AVAILABILITY OF FUNDS FOR THE NEXT FISCAL YEAR (APR 1984) 39

C.8 VAAR 852.232-72 ELECTRONIC SUBMISSION OF PAYMENT REQUESTS (NOV

2018)

C.9 VAAR 852.242-71 ADMINISTRATIVE CONTRACTING OFFICER (OCT 2020)

C.10 52.204-21 BASIC SAFEGUARDING OF COVERED CONTRACTOR INFORMATION

SYSTEMS (NOV 2021)

C.11 VAAR 852.201-70 CONTRACTING OFFICER'S REPRESENTATIVE (DEC 2022)

C.12 VAAR 852.203-70 COMMERCIAL ADVERTISING (MAY 2018)

C.13 VAAR 852.211-76 LIQUIDATED DAMAGES - REIMBURSEMENT FOR DATA

BREACH COSTS (FEB 2023)

C.14 VAAR 852.222-70 CONTRACT WORK-HOURS AND SAFETY STANDARDS—

NURSING HOME CARE FOR VETERANS (MAY 2018)

C.15 VAAR 852.237-74 NON-DISCRIMINATION IN SERVICE DELIVERY (OCT 2019) .44

C.16 VAAR 852.237-70 INDEMNIFICATION AND MEDICAL LIABILITY INSURANCE

(OCT 2019)

C.17 52.212-5 CONTRACT TERMS AND CONDITIONS REQUIRED TO IMPLEMENT

STATUTES OR EXECUTIVE ORDERS—COMMERCIAL PRODUCTS AND

COMMERCIAL SERVICES (NOV 2024)

SECTION D - CONTRACT DOCUMENTS, EXHIBITS, OR ATTACHMENTS

D.1 ATTACHMENT D.1 - QUALITY ASSURANCE SURVEILLANCE PLAN (QASP)

D.2 ATTACHMENT D.2 - WAGE DETERMINATION CHICOT COUNTY

SECTION E - SOLICITATION PROVISIONS

E.1 52.212-1 INSTRUCTIONS TO OFFERORS—COMMERCIAL PRODUCTS AND

COMMERCIAL SERVICES (SEP 2023)

ADDENDUM to FAR 52.212-1 INSTRUCTIONS TO OFFERORS—COMMERCIAL ITEMS

E.2 52.252-1 SOLICITATION PROVISIONS INCORPORATED BY REFERENCE (FEB

1998)

E.3 52.204-24 REPRESENTATION REGARDING CERTAIN TELECOMMUNICATIONS

AND VIDEO SURVEILLANCE SERVICES OR EQUIPMENT (NOV 2021)

E.4 52.209-7 INFORMATION REGARDING RESPONSIBILITY MATTERS (OCT 2018)

E.5 52.233-2 SERVICE OF PROTEST (SEP 2006)

E.6 VAAR 852.233-70 PROTEST CONTENT/ALTERNATIVE DISPUTE RESOLUTION

(OCT 2018)

E.7 VAAR 852.233-71 ALTERNATE PROTEST PROCEDURE (OCT 2018)

E.8 52.212-2 EVALUATION—COMMERCIAL PRODUCTS AND COMMERCIAL

SERVICES (NOV 2021)

ADDENDUM 52.212-2 EVALUATION—COMMERCIAL ITEMS

E.9 52.212-3 OFFEROR REPRESENTATIONS AND CERTIFICATIONS—COMMERCIAL

PRODUCTS AND COMMERCIAL SERVICES (MAY 2024)

SECTION B - CONTINUATION OF SF 1449 BLOCKS

B.1 CONTRACT ADMINISTRATION DATA

1. Contract Administration: All contract administration matters will be handled by the following individuals:

a. CONTRACTOR:

Point of Contact: __________________________

Title: ___________________________________

Phone Number: __________________________

E-Mail: _________________________________

Tax ID No.: ______________________________

SAM UEI: _______________________________

b. GOVERNMENT:

Stephanie Keo, Contracting Officer

Department of Veterans Affairs

Network Contracting Office 16

5075 Westheimer Road, Suite 750

E-Mail: Stephanie.Keo@va.gov

Sheliah Saunders, Contract Specialist

Department of Veterans Affairs

Network Contracting Office 16

5075 Westheimer Road, Suite 750

E-Mail: Sheliah.Saunders@va.gov

2. CONTRACTOR REMITTANCE ADDRESS: All payments by the Government to the contractor will be made in accordance with:

[X] 52.232-33, Payment by Electronic Funds Transfer—System For Award Management, or

[] 52.232-36, Payment by Third Party

3. INVOICES: Invoices shall be submitted in arrears:

a. Quarterly []

b. Semi-Annually []

c. Other [X] Monthly mailto:Stephanie.Keo@va.gov mailto:Sheliah.Saunders@va.gov

4. GOVERNMENT INVOICE ADDRESS: All Invoices from the contractor shall be submitted electronically in accordance with VAAR Clause 852.232-72 Electronic Submission of Payment 5.

INVOICING/BILLING: Contractor shall establish a recordkeeping system of contractor services provided.

6. INVOICE REQUIREMENTS AND SUPPORTING DOCUMENTATION: Reference Performance

Work Statement under Billing for additional information.

7. SECURE FAX: The following statement on all fax cover sheets be included: “This fax is intended only for the use of the person or office to which it is addressed and may contain information that is privileged, confidential, or protected by law. All others are hereby notified that the receipt of this fax does not waive any applicable privilege or exemption for disclosure and that any dissemination, distribution, or copying of this communication is prohibited. If you have received this fax in error, please notify this office immediately at the telephone number listed above.”

8. POST AWARD ORIENTATION: The Contracting Officer will schedule a post award orientation for contract orientation purposes as required by VA Acquisition Manual, Part M842.502-70.

9. EMPLOYMENT REPORTS ON SPECIAL DISABLED VETERANS OF THE VIETNAM ERA,

AND OTHER ELIGIBLE VETERANS (VETS 4212): Offerors in accordance with FAR clause

52.222-37, Employment Reports on Special Disabled Veterans, Veterans of the Vietnam Era, and Other

Eligible Veterans, which is incorporated in this solicitation by reference, and Public Law 105-359, section

1354 (enacted October 31, 1998), the successful offeror must meet the reporting requirement as required by the clause. The contracting officer may require the successful offeror to furnish evidence that it has complied with requirements to file a VETS-4212 Federal Contractor Report (formerly VETS-100) with the Department of Labor for the preceding fiscal year (30 SEP) until Title 38 Section 4212(d) (weblink http://www.dol.gov/vets/vets4212.htm). For questions and information on filing VETS-4212 reports, contract the VETS-4212 Processing Center at (866) 237-0275 or visit the Department of Labor’s web site at http://www.dol.gov/vets/contractor/main.htm. and/or for further assistance or questions VETS4212-customersupport@dol.gov.

10. SYSTEM AWARDS MANAGEMENT SYSTEM (SAM): Federal Acquisition Regulations require all contractors conducting business with the Government be registered in the System Awards

Management System (SAM) online database for the provision of basic information relative to contract awards (see FAR Clause 52.212-4(t)). This may be accomplished at http://www.sam.gov. It is the responsibility of the contractor to renew this registration annually. This information should be the same as the CNHs’ W-9.

11. E-VERIFY: The contractor in accordance with FAR clause 52.222-54, Employment Eligibility

Verification are required to enroll in and use the Department of Homeland Security (DHS), United States

Citizenship and Immigration Services’ (USCIS) electronic employment eligibility verification program

(E-Verify). The Federal government has a long-standing policy to only contract with businesses and other entities that abide by the immigration laws of the United States and to employ only individuals who are authorized to work. E-Verify is the best means to electronically confirm identity and employment authorization of employees working under covered Federal contracts, as required by clause 52.222-54.

USCIS has enhanced the E-Verify website with resource information and outreach materials to assist with enrollment and use of eVerify. USCIS routinely hosts free public webinars on E-Verify and has a detailed

E-Verify.

mailto:VETS4212-customersupport@dol.gov mailto:VETS4212-customersupport@dol.gov

12. SERVICE CONTRACT REPORTING: In accordance with FAR 52.204-15, Service Contract

Reporting Requirements for Indefinite-Delivery Contracts, the contractor is required to report the total amount invoiced and the direct labor hours expended on the services performed under this contract. The information is collected through the System for Award Management (SAM) and included in the agency’s service contract inventory. Contractors are encouraged to review this information and to make note of reporting dates and deliverables to ensure their compliance with the law and regulation. Refer to FAR

4.1703 for thresholds. Indefinite-delivery contracts reporting requirements, which will be based on the expected dollar amount and type of the orders issued under the contracts. FAR 4.1703. See FAR 4.17 -

Service Contracts Inventory. Guidance for contractors is in the “Service Contract Reporting” clause of their contract (52-204-14 or 52.204-15), and in SAM’s Quick Start Guide for Service Contract Reporting, and SAM’s Full User Guides, available at www.SAM.gov under the “Help” tab.

13. REQUIRED REGISTRATION WITH CONTRACTOR PERFORMANCE ASSESSMENT

REPORTING SYSTEM (CPARS)

As prescribed in Federal Acquisition Regulation (FAR) Part 42.15, the Department of Veterans Affairs

(VA) evaluates contractor past performance on all contracts that exceed the simplified acquisition threshold (SAT) as defined in FAR 2.101 and shares those evaluations with other Federal Government contract specialists and procurement officials. The FAR requires that the contractor be provided an opportunity to comment on past performance evaluations prior to each report closing. To fulfill this requirement VA uses an online database, CPARS, which is maintained by the Naval Sea Logistics Center in Portsmouth, New Hampshire. CPARS has connectivity with the Past Performance Information

Retrieval System (PPIRS) database, which is available to all Federal agencies. PPIRS is the system used to collect and retrieve performance assessment reports used in source selection determinations and completed CPARS report cards transferred to PPIRS. CPARS also includes access to the federal awardee performance and integrity information system (FAPIIS). FAPIIS is a web-enabled application accessed via CPARS for contractor responsibility determination information.

Each contractor whose contract award is estimated to exceed the SAT is required to register with CPARS database at the following web address: https://www.cpars.gov/. Help in registering can be obtained by contacting customer support desk @ DSN: 684-1690 or COMM: 207-438-1690. Registration should occur no later than thirty calendar days after contract award and shall be kept current should there be any change to the contractor’s registered representative.

For contracts with a period of one year or less, the CO will perform a single evaluation when the contract is complete. For contracts exceeding one year, the CO will evaluate the contractor’s performance annually. Interim reports will be filed each year until the last year of the contract, when the final report will be completed. The report shall be assigned in CPARS to the contractor’s designated representative for comment. The contractor representative will have thirty calendar days to submit any comments and re-assign the report to the VA CO.

Failure to have a current registration with the CPARS database, or to re-assign the report to the VA CO within those thirty calendar days, will result in the Government’s evaluation being placed on file in the database with a statement that the contractor failed to respond.

14. ACKNOWLEDGMENT OF AMENDMENTS: The offeror acknowledges receipt of amendments to the Solicitation numbered and dated as follows:

http://www.sam.gov/

AMENDMENT NO DATE

(End of B.1 Contract Administration Data)

(End of B.1)

B.2 PRICE/COST SCHEDULE OF SERVICES

In accordance with FAR 16.504 Contract Limitations:

1. Contract IDC Minimum: $1,000.00.

2. Contract IDC Maximum: Maximum dollar value of the contract shall not exceed $7,500,000.00.

VA acknowledges that, depending on the availability of resources at a specific IDIQ holder facility, acceptance of a referral may be commercially impracticable for the IDIQ holder. In that event, the IDIQ holder may decline to accept that referral. Only signed 10-7080s by authorized VA medical center personnel, such as the CNH program coordinator, social worker, and community care RN are considered authorized and complete orders.

NOTE: Any significant change requires the VA to be notified and a new authorization approved by the

VA for those services to begin.

Reference Performance Work Statement (PWS) under requirement for Patient Driven Payment Model

(PDPM) for VA CNH Fee Schedule.

Anticipates Period of Performance:

1st Ordering Period: 03-01-2025 through 02-31-2026

2nd Ordering Period: 03-01-2026 through 02-31-2027

Evaluations of Options - FAR 52.217-8 Option to Extend Services, allows the CO to obtain additional services within the limits and at the rates specified in the contract for a period up to six months if the award of a follow-on contract is delayed due to circumstances beyond the control of the CO. Examples of circumstances causing such delays are bid protests and alleged mistakes in bid. Note: when FAR clause

52.217-8 is included in the solicitations and contracts for services only, evaluate the six-month extension as part of the Government’s initial evaluation. The contract rates may be adjusted only because of revisions to prevailing labor rates provided by the Secretary of Labor or those published rate changes utilized to price the contract. The CO may exercise the option provision more than once, but the total extension of performance hereunder should not exceed 6 months. The CO may exercise the option by written notice to the Contractor within the period specified in the contract.

(End of B.2)

B.3 PERFORMANCE WORK STATEMENT (PWS)

A. Overview

1. Federal Acquisition Regulation (FAR) – Indefinite Delivery Indefinite Quantity

Contract (IDIQ). In accordance with FAR 16.504, Indefinite-Quantity Contracts, this is an

IDIQ with an ordering period of up to two (2) years beginning from the date of award. This requirement is being solicited under the authority of 38 CFR 17.4000, 38 U.S.C. 1710 and 38

U.S.C. 1720.

2. Veteran Placements. Placements may be issued by authorized VA medical center personnel to place Veterans in Nursing Homes. Contact for authorized VA medical center personnel information will be provided separately.

B. 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 Central Arkansas Veterans Healthcare System (CAVHS), in Little Rock, Arkansas at the prices specified in the section titled Schedule of Items of this IDIQ. Nursing home facilities in the CNH program shall cooperate with VA staff in referral of appropriate Veterans for care and 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.

C. Requirements

1. General. Nursing home facilities in the CNH program shall ensure that care meets the health needs and promotes the maximum well-being of VA patients. Nursing home care will be furnished to ensure the total medical, nursing, and psychosocial needs of VA beneficiaries. All nursing home facilities in VA’s CNH program must have current Center for Medicare and Medicaid Services (CMS) certification (Medicare and/or Medicaid) and a

State nursing home license. VA often has a particular need for specialty care services in the

CNH program. 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 will be available at a minimum 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. Duly authorized VA staff will provide quality oversight visits to Veterans placed to assure continuity of care and to assist in the Veterans’ transition back into the community.

These visits do not substitute nor relieve the CNH in any way of the responsibility for the daily care and medical treatment of the Veteran. CNHs shall provide primary medical care, provider visits as needed per month, and specialty consultations, drugs and routine supplies, laboratory, x-ray, and other special services preauthorized by VA. 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.

2. 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.

3. VA Authorizations. Authorization for nursing home care will be submitted on VA Form

10-7080, “Approved Referral for Medical Care.” Each authorization referral period will be noted on the VA Form 10-7080 with a beginning and end date.

4. Patient Driven Payment Model (PDPM). The VA CNH Fee Schedule follows the

Prospective Payment System (PPS) billing requirements found in "Chapter 6–Skilled

Nursing Facility (SNF) Inpatient Part A Billing and SNF Consolidated Billing," Medicare

Claims Processing Manual, Chapter 6, (https://www.cms.gov/regulations-and-guidance/guidance/manuals/downloads/clm104c06.pdf) with some exceptions. This includes

VA paying the lesser of billed charges or the CNH Fee Schedule, the interrupted stay policy and enhanced payments for HIV/AIDS. VA exceptions are published and updated on this VA website, https://www.va.gov/COMMUNITYCARE/revenue-ops/Fee-

Schedule.asp. Contractors are responsible for monitoring changes to this website which will be applied to claims automatically starting on the published effective date. The exceptions provided below are for information only and are superseded by published exceptions posted on the VA website after the contract award date.

Exceptions:

1. VA will use the Patient Driven Payment Model-based (PDPM) pricing software using the following specifications:

1. CNH day 1-100: multiply physical therapy (PT), occupational therapy (OT), speech language pathology (SLP), nursing, and non-case-mix components by 0.93 in addition to any other adjustment factors.

2. CNH day 101+: remove PT, OT, and SLP components (or set adjustment factor to 0). Multiply nursing and non-case-mix components by 1.25.

3. The non-therapy ancillary component will follow PDPM (3.0 for the first three days, 1.0 for CNH day 1-100, and 1.25 for CNH day 101+).

2. No special service pricing exists outside of VA PDPM-based PPS for services such as bed hold, memory care, behavioral, HIV/AIDS, respite, ventilator, tracheostomy, and isolation/private room.

3. VA does not participate in the sequestration, quality reporting, or in the value-based program.

a. VA covers some services under CNH authorizations that are not considered part of the nursing home PPS, listed below. Nursing homes are required to submit separate claims for these services.

a. Physician services: Providers delivering federally mandated or separately authorized services shall bill fee-for-service. The services will be reimbursed at the lesser of billed charges or the Medicare Physician Fee Schedule.

Nursing facilities are required to make claims on behalf of the physician, unless the physician has a Veterans Care Agreement with VA.

b. PT, OT and SLP: When PT, OT or SLP therapy is required during days

101+ of a Veteran’s stay, providers must get prior authorization from VA.

When care is delivered on days 101+ of a Veteran’s stay, providers will bill fee-for-service using the following procedure codes: G0151, G0152, G0153, https://www.cms.gov/regulations-and-guidance/guidance/manuals/downloads/clm104c06.pdf https://www.cms.gov/regulations-and-guidance/guidance/manuals/downloads/clm104c06.pdf https://www.cms.gov/regulations-and-guidance/guidance/manuals/downloads/clm104c06.pdf https://www.cms.gov/regulations-and-guidance/guidance/manuals/downloads/clm104c06.pdf https://www.va.gov/COMMUNITYCARE/revenue-ops/Fee-Schedule.asp https://www.va.gov/COMMUNITYCARE/revenue-ops/Fee-Schedule.asp

G0157, G0158, G0159, G0160, G0161. The services will be reimbursed at the lesser of billed charges or the VA Fee Schedule.

c. Escort services: When an escort to a medical appointment is indicated, providers must get prior authorization from VA. Providers will bill fee-for-service using the following procedure code: G0156. The services paid will be the lesser of billed charges or the VA Fee Schedule.

d. Interrupted Stays: VA follows Medicare’s Interrupted Stay Policy.

e. High-Cost Medication: When a high-cost medication is required during a

Veteran’s stay, providers must get prior authorization from VA. High-cost medication will be reimbursed at the lesser of billed charges or the VA Fee

Schedule. (Note: as of October 1, 2024, the published fee schedule does not address high-cost medication. Once added to the website, changes to the website information supersede this paragraph.)

5. 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).

6. Rehabilitation Criteria. Follow CMS Medicare chapter on Maintenance Therapy.

Therapy requires pre-approval by VA.

7. Emergency Care; Financial Responsibility; Advanced Directives. Veterans may have coverage for emergency care when the CNH alerts the VA within 24 hours of the care. The

CNH will qualify for VA reimbursement of emergency care and ancillary transportation, provided that the CNH or private hospital contacts the VA Health Care System (VAHCS) within 72-hours of admission or first business day following a weekend or holiday. This includes the cost of necessary transportation for such care. Use of a VA or VA network medical facility is preferred.

8. HIPAA Compliance. HIPAA compliance is required. The Contractor must 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.

9. Quality Expectations for CNH’s:

a. To participate in VA’s CNH Program, NHs are expected to have either 1) a three-star overall rating, or 2) a two-star overall rating with a four star or greater quality measures score on the Centers for Medicare and Medicaid (CMS) Nursing Home

Compare Web site (https://www.medicare.gov/nursinghomecompare/search.html).

b. NHs with lower scores may participate in the CNH program only when specifically approved by the Deputy Under Secretary for Health for Operations and Management or designee.

c. All NHs in the CNH Program must be certified by CMS under Title XVIII

(Medicare) or Title XIX (Medicaid) or have received special approval from the Office of

Geriatrics and Extended Care (GEC) Office. NHs are responsible to the state of jurisdiction and CMS for the care provided. VA does not regulate the care or inspect

CNHs. VA acts as an informed purchaser of care in order to purchase quality services for

Veterans and enhance the Veterans’ experience in the home.

d. 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 CAVHS VA Home and Community Care Department at 501-765-7268. VA will monitor the professional care and administrative management of services provided to VA beneficiaries under this IDIQ (reference 9.a.).

(QASP Indicator #1) The CNH shall cooperate fully with VA’s quality improvement or quality assurance program functions relating to this IDIQ. The VA Contracting Officer shall make all final determinations as to the Contractor’s reasonable cooperation with VA and compliance with these requirements.

10. 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 or Medicare surveys. The CNH will provide copies of CAPs to VA.

11. Re-admission to the VA Hospital and Emergency Care; Notification of Death of

Veterans; CNH Responsibility for 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.

a. 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 hours of admission of the patient to a non-Federal facility and notice of any Veteran death within 24 hours or immediately upon the first business day after a weekend or holiday. If hospitalization of a non-emergency nature is required, readmission to a

VA Medical Center may be accomplished as soon as the patient’s condition is sufficiently stabilized to permit admission to a VA Medical Center.

b. In the event of a death of any Veteran, the Contractor agrees to notify VA immediately of the death. In the event a death of a VA beneficiary while receiving nursing home care under this IDIQ, the CNH will 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 https://www.medicare.gov/nursinghomecompare/search.html 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.

c. 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 that authorized 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 will 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.

12. Reportable Events (QASP Indicator #4). VA requires CNHs to report to the CNH

Coordinator at VA any of the below events within 24-hours or immediately upon the first business day after a weekend or holiday. Reporting shall include date of occurrence and patient disposition and outcome.

1. Sentinel events;

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

3. When there is a change of nursing home administrator or Director of

Nursing/Director of Nursing Service;

4. substantiated allegations of mistreatment, neglect, abuse or misappropriation of CNH

Veterans or property;

5. Elopements of CNH Veterans pursuant to state regulations;

6. Infectious outbreaks;

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

8. Copies of annual surveys or substantiated complaint investigations conducted by a

State oversight agency; and

9. Adverse events.

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

1. A fall resulting in death or injury;

2. Elopement resulting in a missing patient;

3. Patient abuse confirmed or under suspicion;

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

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

6. Death related to an unconfirmed or suspicious cause.

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.

13. 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 IDIQ and applicable procurement regulations:

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

b. Suspend placement of Veterans in the CNH;

c. Remove or transfer Veterans under the IDIQ from the subject CNH;

d. Not renew the IDIQ; and/or

e. Terminate the IDIQ.

14. 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. Selected VA staff will be provided access to the CNH electronic health record for each Veteran. 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 in accordance with CMS standards in 42 CFR 483.

15. Non-VA Specialty Care Services. The CNH shall notify VA program staff of the need for specialty care services for Veterans (examples include dental care, podiatry, and ophthalmology). Payment is based on the method of care authorized by VA.

16. Contact Information for VA Appointments/Admissions/Specialty Care.

(a) For urgent same-day outpatient specialty care or for non-urgent scheduled clinic appointments/consultations, phone number 501-257-5714 between 9 a.m. and 3 p.m.

Monday through Friday, excluding holidays. If a same-day appointment is anticipated;

please call as early as possible.

(b) For non-emergency consultation or /evaluation for admission to the

CAVHS (after initial evaluation or intervention by the nursing home physician) call phone number 501-257-5714.

(c) For urgent referrals or consultation after hours, weekends and holidays, call 501-

257-5714.

(d) For transportation to and from the VA facility for appointments, evaluation, or hospitalization, call 501-257-1974 or 501-257-2621. Transportation will be arranged and paid by the VA for CNH patients when requested.

17. Soliciting Charitable Contributions. The CNH will not directly solicit contributions, donations, or gifts from Veteran patients or a Veteran’s family members. CNH-wide charitable fundraising activities such as United Way are allowed.

18. Prices/Rates

VA shall pay, and Provider shall accept, the following amounts as payment for Covered

Services under this Contract: The lesser of billed charges or the VA Fee Schedule amount for the period in which the Covered Service was performed, as posted and contemporaneously available on VA.gov on the date of service. For purposes of this Contract, the “VA Fee

Schedule amount” is a per diem rate determined by VA as set forth in the formula posted on

VA.gov.

19. Claims Submission and Adjudication (QASP Indicator #6).

Provider shall always submit all claims within 180 days of the date of service. Claims must be submitted to the VA facility that issued the authorization. Electronic claims must be submitted by Electronic Data Interchange (EDI) using the following payer ID: 12115. Paper claims must be submitted in accordance with the instructions on the community care website on VA.gov.

Provider shall always submit clean claims. VA will only process and pay clean claims. A

“clean claim” means a claim that contains all of the required data elements necessary for accurate adjudication, without obtaining additional information from the submitter, and which complies with all applicable VA requirements regarding information, documentation, and format, including the following specific requirements:

(a) Containing Provider’s name, address, and Taxpayer Identification Number (TIN).

(b) Containing the correct VA beneficiary identifiers, including Social Security Number.

(c) Containing the numbers of this Contract and the applicable VA authorization(s).

(d) Containing all information required by VA to determine the applicable VA Fee Schedule amount for the period in which the service was performed. Such information may include, but will not necessarily be limited to, HIPPS codes and/or minimum data sets or other data from or relating to resident assessments. VA will provide written notice of all required information prior to the applicable date(s) of service. Provider represents and warrants that any information submitted to VA pursuant to this paragraph J.2(d) accurately reflects the resident’s status and/or the Covered Services furnished, as applicable.

(e) Applying industry standard edits consistent with the current version of the CMS National

Correct Coding Initiative (NCCI) Coding Policy Manual.

(f) For institutional paper claims, complying with all content requirements set forth in the current version of the National Uniform Billing Committee (NUBC) Official UB-04 Data

Specifications Manual.

(g) For professional paper claims, complying with all content requirements set forth in the current version of the National Uniform Claim Committee (NUCC) 1500 Claim Form

Reference Instruction Manual.

(h) For electronic claims, complying with all content requirements set forth in the current version of the American National Standards Institute (ANSI) Accredited Standards

Committee (ASC) X12 Health Care Claim (837) transaction Type 3 Technical Reports-TR3.

(i). If a claim is denied, VA will notify Provider in writing of the reason for denying the claim and what, if any, additional information is required to process the claim. VA will provide such notification within 45 calendar days of receipt of a paper claim and within 30 calendar days of receipt of an electronic claim. Provider must submit all additional information requested by VA within 30 calendar days of receipt of VA’s notice of denial.

Such information must be submitted to the VA facility that issued the authorization, in accordance with the requirements of this section. VA will pay, deny, or otherwise adjudicate the claim within 30 calendar days of receipt of the requested information.

(j) Provider will also submit a copy of claim at the time of submission to authorized VA medical center personnel. This is for clinical review and will not delay payment through the automated system.

20. Payment

VA shall pay Provider, upon submission of clean claims, the amounts set forth in this

Contract for Covered Services furnished and accepted. Payment will be made within 30 calendar days of receipt of a clean electronic claim and within 45 calendar days of receipt of clean paper claim.

Payment by Electronic Funds Transfer

Method of payment.

(a) All payments by VA under this Contract shall be made by electronic funds transfer (EFT), except as provided in paragraph (a)(2) of this clause. As used in this clause, the term “EFT” refers to the funds transfer and may also include the payment information transfer.

(b) In the event VA is unable to release one or more payments by EFT, Provider agrees to either

(1) Accept payment by check or some other mutually agreeable method of payment; or

(2) Request VA to extend payment due dates until such time as VA makes payment by EFT

(but see paragraph (d) of this clause).

Mandatory submission of Provider’s EFT information. Provider is required to provide the

Government with the information required to make payment by EFT (see paragraph (j) of this clause). Provider shall provide this information directly to the office designated in this contract to receive that information (the Designated Office') by no later than 10 business days prior to submission of the first claim. If not otherwise specified in this Contract, the payment office is the Designated Office for receipt of the Provider’s EFT information. If more than one Designated Office is named for the Contract, Provider shall provide a separate notice to each office. In the event that the EFT information changes, Provider shall be responsible for providing the updated information to the Designated Office(s).

Mechanisms for EFT payment. VA may make payment by EFT through either the

Automated Clearing House (ACH) network, subject to the rules of the National Automated

Clearing House Association, or the Fedwire Transfer System. The rules governing Federal payments through the ACH are contained in 31 CFR part 210.

Suspension of payment.

(1) VA is not required to make any payment under this Contract until after receipt, by the

Designated Office, of the correct EFT payment information from Provider. Until receipt of the correct EFT information, any claim shall be deemed not to have been received by VA for purposes of determining payment due date.

(2) If the EFT information changes after submission of correct EFT information, VA shall begin using the changed EFT information no later than 30 calendar days after its receipt by the Designated Office to the extent payment is made by EFT. However, Provider may request that no further payments be made until the updated EFT information is implemented by the payment office.

Liability for uncompleted or erroneous transfers.

(1) If an uncompleted or erroneous transfer occurs because VA used the Contractor's EFT information incorrectly, VA remains responsible for:

(a) making a correct payment; and

(b) recovering any erroneously directed funds.

(2) If an uncompleted or erroneous transfer occurs because Provider’s EFT information was incorrect, or was revised within 30 days of VA release of the EFT payment transaction instruction to the Federal Reserve System, and

(a) If the funds are no longer under the control of the payment office, VA is deemed to have made payment and Provider is responsible for recovery of any erroneously directed funds; or

(b) If the funds remain under the control of the payment office, VA shall not make payment and the provisions of paragraph (d) shall apply.

EFT and timing of payment. A payment shall be deemed to have been made in a timely manner in accordance with the terms of this Contract if, in the EFT payment transaction instruction released to the Federal Reserve System, the date specified for settlement of the payment is on or before the due date, provided the specified payment date is a valid date under the rules of the Federal Reserve System.

EFT and assignment of claims. If Provider assigns the proceeds of this Contract as provided for in the assignment of claims terms of this Contract, Provider shall require as a condition of any such assignment, that the assignee shall provide the EFT information required by paragraph (j) of this clause to the Designated Office, and shall be paid by EFT in accordance with the terms of this clause. In all respects, the requirements of this clause shall apply to the assignee as if it were Provider. EFT information that shows the ultimate recipient of the transfer to be other than Provider, in the absence of a proper assignment of claims acceptable to VA, is incorrect EFT information within the meaning of paragraph (d) of this clause.

Liability for change of EFT information by financial agent. VA is not liable for errors resulting from changes to EFT information provided by Provider’s financial agent.

Invoices for board, 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 will promptly notify the VA CNH Coordinator 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 invoices must include the full name and address of the CNH and shall reflect the patient’s name, social security number, number of days billed, RUG category (ies), and agreed upon RUG rate (s). Failure to include this information may result in delayed payment. The current CNH

Billing Cover Sheet can be obtained from the Integrated Veterans Care (IVC) department at

[PHONE #].

Pre-approved services billed by CMS procedures or CPT codes: All services which are pre-approved by VA as additional 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.

High-cost drugs: All requests for additional reimbursement for high cost drugs and corresponding billing are due as soon as possible, but no later than 90 calendar days after use of products.

Invoices: Corrected invoices must be submitted for additional payment of any ancillary costs or changes to the original billing. All corrected invoices must include all items that are affected by the change and should include the CNH corrected claim form [VA Integrated Veterans Care

(IVC) department, 501-257-2577.

21. PRICES/RATES

VA shall pay, and Provider shall accept, the following amounts as payment for Covered Services under this Contract: The lesser of billed charges or the VA Fee Schedule amount for the period in which the Covered Service was performed, as posted and contemporaneously available on

VA.gov on the date of service. For purposes of this Contract, the “VA Fee Schedule amount” is a per diem rate determined by VA as set forth in the formula posted on VA.gov.

PAYMENT (CONTINUED)

Payment information. The payment or disbursing office shall forward to Provider available payment information that is suitable for transmission as of the date of release of the EFT instruction to the Federal Reserve System. VA may request Provider to designate a desired format and method(s) for delivery of payment information from a list of formats and methods the payment office is capable of executing. However, VA does not guarantee that any particular format or method of delivery is available at any particular payment office and retains the latitude to use the format and delivery method most convenient to VA. If VA makes payment by check in accordance with paragraph (a) of this clause, VA shall mail the payment information to the remittance address in this Contract.

EFT information. Provider shall provide the following information to the Designated Office.

Provider shall designate a single financial agent capable of receiving and processing the EFT information using the EFT methods described in paragraph (c) of this clause.

(1) The Contract number.

(2) Provider’s name and remittance address, as stated in the Contract.

(3) The signature (manual or electronic, as appropriate), title, and telephone number of the

Provider official authorized to provide this information.

(4) The name, address, and 9-digit Routing Transit Number of Provider’s financial agent.

(5) Provider’s account number and the type of account (checking, saving, or lockbox).

(6) If applicable, the Fedwire Transfer System telegraphic abbreviation of Provider’s financial agent.

(7) If applicable, Provider shall also provide the name, address, telegraphic abbreviation, and 9-digit Routing Transit Number of the correspondent financial institution receiving the wire transfer payment if Provider’s financial agent is not directly on-line to the Fedwire Transfer

System; and, therefore, not the receiver of the wire transfer payment.

Vendorization. Prior to submitting a claim, Provider must ensure the authorizing VA facility has received a completed FMS Vendor File Request form (VA Form 10091) and W-9, Request for

Taxpayer Identification Number and Certification and all information contained therein is current and accurate.

Prompt Payment by VA.

(1) Interest penalty. The designated payment office will pay an interest penalty automatically, without request from Provider, if payment is not made by the due date and the conditions listed in paragraphs (a)(1) and (a)(2) of this clause are met, if applicable. However, when the due date falls on a Saturday, Sunday, or legal holiday, the designated payment office may make payment on the following working day without incurring a late payment interest penalty.

(a) VA received a clean claim in accordance with Section 19(j).

(b) VA processed a receiving report or other VA documentation authorizing payment, and there was no disagreement over payment amount, compliance of services furnished with any term or condition of this Contract, or Provider compliance with any other term or condition of this

Contract.

(2) Computing penalty amount. The interest penalty shall be computed at the rate of interest established by the Secretary of the Treasury under section 3902 of title 31 U.S.C. and published in the Federal Register.

Overpayments.

(1) If Provider becomes aware of a duplicate VA payment or that VA has otherwise overpaid under the Contract, Provider shall:

(a) Remit the…