S02 36C24521Q0436.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. DUNS: DUNS+4:

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. 2/2012)

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

7. FOR SOLICITATION

INFORMATION CALL:

STANDARD FORM 1449

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

SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL ITEMS 83

36C24521Q0436 09-01-2021

Keith Roberts (keith.roberts@va.gov) 410-642-2411 x22921 10-04-2021

08:00 ET

Keith Roberts, Contracting Specialist VA Maryland Health Care System Contracting Officer (90C) P.O. Box 1000, Bldg. 101, Room 26 Perry Point MD 21902

X

623110

$30 Million

N/A

Department of Veterans Affairs

Contracting Officer (90C) P.O. Box 1000, Bldg. 101, Room 26

Contracting Officer (90C) P.O. Box 1000, Bldg. 101, Room 25

Beckley VA Medical Care in the Community 200 Veterans Ave Beckley, WV 25801 Attn: JoAnn D. Carper

See CONTINUATION Page

The contractor shall provide nursing home services for beneficiaries of the Department of Veterans Affairs Medical Center in the Beckley, West Virginia catchment area in accordance with the performance work statement.

Quotation packages are due no later than October 4, 2021 at 8:00 a.m. (Eastern Time).

X ONE (1)

Paschal L. Dawson Contracting Officer

36C24521Q0436

Table of Contents

SECTION A

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

SECTION B - CONTINUATION OF SF 1449 BLOCKS

B.1 CONTRACT ADMINISTRATION DATA

B.2 SCHEDULE OF ITEMS

B.3 PRICE/COST SCHEDULE

B.4 PERFORMANCE WORK STATEMENT

B.5 SHARED CAPACITY -- MULTIPLE AWARD TASK ORDER CONTRACTS

(MATOCs)

VETERAN PATIENT REFERRAL TASK ORDERS

B.6 CONTRACTOR’S RESPONSIBILITY – CPARS

SECTION C - CONTRACT CLAUSES

C.1 52.204-21 BASIC SAFEGUARDING OF COVERED CONTRACTOR

INFORMATION SYSTEMS (JUN 2016)

C.2 52.212-4 CONTRACT TERMS AND CONDITIONS—COMMERCIAL ITEMS (OCT

2018)

C.3 52.212-5 CONTRACT TERMS AND CONDITIONS REQUIRED TO IMPLEMENT

STATUTES OR EXECUTIVE ORDERS—COMMERCIAL ITEMS (JAN 2021) (JUL 2020)

(DEVIATION)

C.4 52.216-18 ORDERING (AUG 2020)

C.5 52.216-19 ORDER LIMITATIONS (OCT 1995)

C.6 52.216-22 INDEFINITE QUANTITY (OCT 1995)

C.7 52.216-32 TASK-ORDER AND DELIVERY-ORDER OMBUDSMAN (SEP 2019) ..37

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

C.9 52.222-49 SERVICE CONTRACT LABOR STANDARDS – PLACE OF

PERFORMANCE UNKNOWN (MAY 2014)

C.10 52.232-19 AVAILABILITY OF FUNDS FOR THE NEXT FISCAL YEAR (APR

1984)

C.11 52.237-3 CONTINUITY OF SERVICES (JAN 1991)

C.12 52.252-2 CLAUSES INCORPORATED BY REFERENCE (FEB 1998)

C.13 VAAR 852.212-70 PROVISIONS AND CLAUSES APPLICABLE TO VA

ACQUISITION OF COMMERCIAL ITEMS (APR 2020)

C.14 VAAR 852.242-71 ADMINISTRATIVE CONTRACTING OFFICER (OCT 2020) ..41

C.15 MANDATORY WRITTEN DISCLOSURES

SECTION D - CONTRACT DOCUMENTS, EXHIBITS, OR ATTACHMENTS

D.1 RUG-IV DESCRIPTIONS

D.2 QUALITY ASSURANCE SURVEILLANCE PLAN (QASP)

D.3 WAGE DETERMINATION SCHEDULES

WAGE DETERMINATION NO. 2015-4295

SECTION E - SOLICITATION PROVISIONS

E.1 52.204-24 REPRESENTATION REGARDING CERTAIN TELECOMMUNICATIONS

AND VIDEO SURVEILLANCE SERVICES OR EQUIPMENT (OCT 2020)

E.2 52.209-7 INFORMATION REGARDING RESPONSIBILITY MATTERS (OCT 2018)

E.3 52.212-1 INSTRUCTIONS TO OFFERORS—COMMERCIAL ITEMS (JUN 2020) 58

INSTRUCTIONS FOR SUBMISSION OF QUOTES

E.4 52.212-2 EVALUATION—COMMERCIAL ITEMS (OCT 2014)

E.5 52.212-3 OFFEROR REPRESENTATIONS AND CERTIFICATIONS—

COMMERCIAL ITEMS (FEB 2021) (JUL 2020) (DEVIATION)

E.6 52.216-1 TYPE OF CONTRACT (APR 1984)

E.7 52.229-11 TAX ON CERTAIN FOREIGN PROCUREMENTS—NOTICE AND

REPRESENTATION (JUN 2020)

E.8 52.233-2 SERVICE OF PROTEST (SEP 2006)

E.9 52.252-1 SOLICITATION PROVISIONS INCORPORATED BY REFERENCE (FEB

1998)

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: Name:

Address:

Point of Contact:

Email:

Phone:

b. GOVERNMENT:

Paschal L. Dawson, Contracting Officer VA Maryland Health Care System Baltimore Annex 209 W. Fayette Street, Suite D605 Baltimore MD 21201-3403

Contracting Officer (90C) P.O. Box 1000, Bldg 101, Room 25 Perry Point, MD 21902

2. CONTRACTOR REMITTANCE ADDRESS: All payments by the Government to the contractor should be mailed to the following address: N/A

3. INVOICES: Invoices shall be submitted in arrears:

a. Quarterly []

b. Semi-Annually []

c. Other [X] MONTHLY

4. GOVERNMENT INVOICE ADDRESS: All invoices from the contractor shall be submitted to the following address:

Beckley VA Medical Center Care in the Community 200 Veterans Ave

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

AMENDMENT NO DATE

B.2 SCHEDULE OF ITEMS

1. Rate Determination: The VA is seeking preferred rates, based on patient care need. VA rates are an all-inclusive per diem rate. The per diem rate(s) will apply throughout the term of this Indefinite Delivery Contract (IDC). While the VA uses State Medicaid rates as a reference, VA rates are independent of those payment systems and governed by the terms of this IDC.

The per diem rate utilizes the Medicare Resident Assessment Instructions (RAI)/Minimum Data Set (MDS) assessment and RUGS score as the reference for rates. Assessment schedules identical to Medicare will be used; in addition, the VA reserves the right to request a resident re-assessment at any time during the coverage period.

2. Rate Adjustments: Rate adjustments may be requested by either the VA or the Contractor’s authorized Community Nursing Home (CNH) representative during the term of this IDC. Request for Rate adjustments must be accompanied by a justification for consideration by the Contracting Officer. If approved, the IDC must be modified and signed by both the Contractor and the VA Contracting Officer. The effective date of the rate adjustment will be the actual “Effective Date” as indicated on the IDC or the modification.

3. Rehabilitation Therapy: Any type of rehabilitation therapy (physical therapy, occupational therapy, speech therapy, etc.) requires the pre-approval of the VA before the initiation of therapy.

4. 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.

5. Private Rooms: A private room rate for clinical concerns such as communicable diseases or infections (e.g., MRSA, VRE), or other pertinent clinical needs may be charged above the negotiated RUG rate for that facility with prior approval by the VA CNH Coordinator or designated VA staff. However, no additional private room charge will be allowed in the following circumstances: where the CNH only maintains private rooms; no double-occupancy rooms are available; and for ventilator-dependent patients with prior-negotiated rates.

6. Ventilator Care: Veterans requiring the use of a ventilator will only be placed in a CNH-trained and equipped for those types of specialty patients. The CNH must be inspected and approved by the VA prior to any placements in the ventilator-designated room. Rates for ventilator care will be detailed in the pricing schedule and will be an all-inclusive per diem rate (including ventilator and supplies).

7. Specialized Prosthetics Equipment (e.g., special bed and/or bariatric equipment:

Veterans may be eligible for specialized equipment when clinically indicated. Pre-approval required by VA.

(END SCHEDULE OF ITEMS)

B.3 PRICE/COST SCHEDULE

1. Contract Minimum and Maximum Value: The guaranteed minimum amount to be awarded under this multiple award task order contract (“MATOC”) is one veteran overnight stay at the lowest CLIN; the maximum amount to be awarded under this contract is $6,771,401.75.

This ceiling is the maximum amount regardless of any options exercised. Total shared capacity for all MATOCs awarded under this solicitation is $6,771,401.75.

2. Period and Place of Performance: The period of performance will be November 1, 2021 through October 31, 2025, or once the contract ceiling is reached, or once the shared capacity threshold is reached, whichever occurs first. Vendor facilities must be located within the Beckley VA Medical Center catchment area which includes West Virginia counties of: Clay, Fayette, Greenbrier, McDowell, Mercer, Monroe, Nicholas, Pocahontas, Raleigh, Wyoming; and the Virginia county of Tazewell.

3. Pricing Formula for Contract: Through the duration of the contract, pricing will be based on the current state Medicaid per diem rate for the facility. Each contract line item (“CLIN”) will be “marked-up” by a fixed percentage that will remain fixed over the lifetime of the contract. Initial pricing will be based on the line item pricing quoted by the vendor in response to this solicitation. The fixed percentage will then be calculated from this initial pricing by the VA and included in the awarded IDIQ. Accordingly, vendor must submit current state Medicaid per diem rate letter along with its quotation package.

Medicaid RUGS IV Pricing Schedule

Enter Current State Medicaid Rate:5 _______

Effective Date of the State Medicaid Per Diem Rate: ______

CLIN RUG-IV Category4 PER DIEM RATE 0001 Reduced Physical, Behavior, and/or Cognitive

Performance RUG-IV Levels Included:

PE2, PE1, PD2, PD1, PC2, PC1, PB2, PB1, PA2, PA1

0002 Basic Care

BA2, BA1, BB2, BB1

0003 Clinically Complex RUG-IV Levels Included:

CE2, CE1, CD2, CD1, CC2, CC1, CB2, CB1, CA2, CA1

0004 Special Care Low RUG-IV Levels Included:

LE2, LE1, LD2, LD1, LC2, LC1, LB2, LB1

0005 Special Care High RUG-IV Levels Included:

HE2, HE1, HD2, HD1, HC2, HC1, HB2, HB1

0006 Extensive Services (Trach / Vent / Respirator / Isolation) RUG-IV Levels Included:

ES1, ES2, ES3

0007 Rehabilitation

RUA, RUB, RUC, RVA, RVB, RVC, RHA, RHB, RHC, RMA, RMB, RMC, RLA, RLB

CLIN RUG-IV Category4 PER DIEM RATE 0008 Rehabilitation + Extensive Services

RHX, RHL, RMX, RML, RLX, RUX, RUL, RVX, RVL

4. RUG-IV Descriptions: See Section D.1 below for a complete listing and description of

RUG-IV categories.

5. Medicaid Rate Increases: Rate increases may be requested once per year. To make the request, the contractor must transmit via email a copy of the state Medicaid notification letter. Medicaid rate increases shall be made effective only on or after the date the contractor submits the Medicaid letter to the Contracting Officer and/or COR. No retroactive rate increases will be made.

(End of Price/Cost Schedule)

B.4 PERFORMANCE WORK STATEMENT

A. Overview

1. Federal Acquisition Regulation (FAR) – Indefinite Delivery Contract (IDC). In accordance with FAR 16.504, Indefinite-Quantity Contracts, this is an IDC for the time period November 1, 2021 through October 31, 2025.

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 IDC. The VA “Levels of Care” are defined in an attachment in Section D.1 of the solicitation and the IDC. VA is obligated only to the extent authorized placement of patients is made in accordance with this IDC.

3. Ordering. Orders will be issued by Ordering Officers to place Veterans in Nursing

Homes, often on a sole source basis using an Exception to Fair Opportunity and utilizing the CPRS system at VA hospital sites (Reference FAR 16.505 (b)(2)(i)(B)). Ordering Officer Contact information is as follows:

Ordering Officer Name: Taylor Harvey Address Beckley VA MEDICAL CENTER 200 Veterans Ave

Beckley, WV 25801 Telephone number 304-255-2121 EXT 4992 E-mail address Taylor.Harvey1@va.gov Facsimile number 1-304-256-5301

Agency task and delivery order ombudsman (see 16.505(b)(8)) if multiple awards may be made.

B. 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 Beckley VAMC, in Beckley, WV at the prices specified in the section titled Schedule of Items of this IDC. 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. VA shall have the right to inspect 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.

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 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 Handbook 1143.2, “VHA Community Nursing Home Oversight Procedures (June 4, 2004) a copy of which is available at:

https://www.acquisition.gov/far/current/html/Subpart%2016_5.html#wp1095799 https://www.acquisition.gov/sites/default/files/current/far/html/Subpart%2016_5.html#wp1095799 http://www.va.gov/vhapublications/publications.cfm?pub=2. 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 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. Duly authorized representatives of VA 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. The per diem rate(s) established in this IDC will include the cost of primary medical care, one (1) provider visit per month and needed consultation, drugs and routine supplies, laboratory, x-ray, and other special services authorized by VA, unless otherwise specifically excepted (see Schedule of Items in this IDC for details regarding per diem rates and coverage). 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 10-7078, “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.

4. Medicaid-Based Rates. The current State Medicaid rates may be used as a basis for determination of Contract Line Item Per Diem rates. The Contract Line Item Per Diem 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.

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. All therapy provided under this IDC will be individual therapy, rather than group therapy, unless otherwise ordered by the authorizing VA facility. Therapy may 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.

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

a. 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.

b. 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.

7. 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 is 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.

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. 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 Beckley VAMC Home and Community Care Department at (304) 255-2121 x4921. VA will monitor the professional care and administrative management of services provided to VA beneficiaries under this IDC, 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 IDC, 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.

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, 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:

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

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

c. 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;

d. 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

e. Provide dates when corrective action will be completed.

11. 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 IDC 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 IDC 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:

a. 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;

b. 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;

c. Natural disasters. In the event of a natural disaster (flood, tornado, 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

d. 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 the time of renovation or alteration.

12. 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.

13. 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.

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-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. 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 IDC, 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 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 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 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.

14. Leave of Absence (LOA) - Bed Holds Not Authorized by VA. Beckley VAMC does not authorize payments for bed holds. In the case of re-hospitalizations or therapeutic passes, or any other LOA that results in the resident not returning to the facility by midnight on the same day of departure, the CNH must make arrangements directly with the veteran/family for payment of the bed hold. Absences of fifteen (15) consecutive calendar days or more, whether in a VA or in a non-federal facility, requires a new authorization agreement.

15. 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:

a. Sentinel events;

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

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

d. substantiated allegations of mistreatment, neglect, abuse or misappropriation of CNH veterans or property;

e. Elopements of CNH veterans pursuant to state regulations;

f. Infectious outbreaks;

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

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

i. Adverse events.

Reporting shall include date of occurrence and patient disposition and outcome.

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

a. A fall resulting in death or injury;

b. Elopement resulting in a missing patient;

c. Patient abuse confirmed or under suspicion;

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

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

f. 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.

16. 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 IDC 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 IDC from the subject CNH;

d. Not renew the IDC; and/or

e. Terminate the IDC.

17. VA Staff Access to CNH Records (QASP Indicator #5). All medical records concerning the veteran’s care in the CNH will 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:

a. VAHCS Referral Package to the CNH:

1. Copy of Physician Orders for Nursing Home Care; CPRS Notes; Discharge Summary including History & Physical information with Medication List;

Rehabilitation Progress Notes; and Veteran Demographic Record which includes next of kin information.

2. Copy of Authorization Agreement (VAF 10-7078).

b. Nursing Home Clinical Record: The CNH must 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:

1. Sufficient information to identify the resident;

2. A record of the veteran’s assessments, including those assessments performed by services under the IDC with the CNH;

3. The plan of care and services including medication administration, provided by CNH staff and services provided under the IDC with the CNH;

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

5. Medical practitioner orders which are signed and dated;

6. Allergies;

7. Person to contact in an emergency situation;

8. Name of attending medical practitioner; and

9. Advanced directives if available.

c. Clinical Record Safeguards: The CNH must 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.

18. Specialty Services. The CNH will assume responsibility for arranging specialty care for veterans (e.g., dental care, podiatry and ophthalmology).

19. VA Health Care System Consultation/Resources.

a. For admissions please contact the Community Care Coordinator at 304-255-2121 ext. 4921 for advice or 304-255-2121 ext. 4243 the AOD after hours.

b. After hours, weekends and holidays: Please contact the Emergency Room at 304-

255-2121 ext. 4243.

c. Transportation: Necessary transportation to and from the VA hospital for clinics, evaluation or hospitalization will be arranged and paid by the VA hospital for CNH patients when requested. For Transportation arrangements please call 304-255- 2121 ext. 4693 or AOD 4243 after hours.

d. Reports of Sentinel and Adverse Events with regards to Veterans under VA contract immediately contact the Social Work Department at 304-255-2121 ext. 4921. After hours, weekends, and holidays please contact the AOD at 304-255-2121 ext. 4243.

20. 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.

21. CNH Billing (QASP Indicator #6). 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.

a. 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.

b. 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.

c. 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 to JoAnn D. Carper at 304-255-2121 ext 4921.

Invoices will be mailed to:

Beckley VA Medical Center Care in the Community 200 Veterans Ave Beckley, WV 25801

Joann.carper@va.gov

22. Minimum Quantities; VA Payment; Contract Ceiling. It is impossible to determine the exact or estimated amount, which will be expended under this IDC. No obligation will be incurred by VA under this IDC, 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 IDC. 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. The aggregate total dollar value of all orders placed under contracts resulting from solicitation 36C24521Q0436 shall not exceed $6,771,401.75.

23. VA Payments. Payments made by VA under any contract pursuant to this IDC, constitute the total cost of nursing home care. No additional charges will be billed to Medicare (with the exception of 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. Unless permitted, 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.

a. 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.

b. 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 to:

Beckley VA Health Care System Care in the Community

200 Veterans Ave

(End of Performance Work Statement)

B.5 SHARED CAPACITY -- MULTIPLE AWARD TASK ORDER CONTRACTS

(MATOCs)

The government has included 52.216-27 in Section E, below, and may make multiple awards under this solicitation. Each Multiple Award Task Order Contract (“MATOC”) awarded under this solicitation shall be a fixed price Indefinite Delivery Indefinite Quantity (IDIQ) contract.

The minimum dollar amount guaranteed under each awarded MATOC is the price of one veteran overnight stay at the lowest CLIN rate at the time of award. The minimum guarantee will be awarded concurrently with the award of each MATOC but will not be billed until the end of the performance period. If, during the performance period, no veterans are placed at the vendor’s facility, the vendor shall bill the VA for the minimum guarantee within 30 days of the end of the performance period. Otherwise, the minimum guarantee will have been fulfilled through the placement of referred veterans, and no additional invoicing will be required.

The maximum dollar amount or contract ceiling for each MATOC shall be $6,771,401.75. The maximum amount is not a guarantee. The combined total of all orders placed against each MATOC cannot exceed the maximum amount (“ceiling”) of each MATOC. The aggregate total of all orders placed against all MATOCs awarded under this solicitation (“shared capacity”) shall not exceed $6,771,401.75. Should the ceiling on any MATOC be reached prior to the end of the performance period, the contract shall be considered fully performed and no additional orders may be placed against it. Should the shared capacity across all MATOCs awarded under the solicitation be reached prior to the end of the performance period, all MATOCs shall immediately be considered fully performed and no additional orders may be placed against any MATOC. If the vendor accepts an order after the end of the performance period, or after the individual MATOC ceiling is reached, or after the shared capacity across all MATOCs has been reached, the order shall be considered an unauthorized commitment and subject to VA agency ratification procedures under FAR 1.602-3 and VAAR 801.602-3. VA will provide at least 60 days’ notice to MATOC holders if it is anticipated that shared capacity will be reached prior to the end of the performance period.

VETERAN PATIENT REFERRAL TASK ORDERS

Task orders under MATOCs awarded under this solicitation come in the form of a veteran referral made by VA. The task order scope includes all services to be rendered to the veteran for the duration authorized by the VA. The location of the veteran’s home, their family, and the veteran’s care network is highly individualized making the veterans care requirement unsuitable for competition at the task order level. Instead, the VA takes every action to ensure that no MATOC holder is endorsed over any other in referral selection, leaving the choice of facility entirely to the veteran and family and their needs.

B.6 CONTRACTOR’S RESPONSIBILITY – CPARS

Information Regarding Contractor Performance Assessment Reporting System (CPARS)

– CONTRACTOR’S Responsibility

This contract will require reporting by the Veterans Health Administration (VHA) in the Contractor Performance Assessment Reporting System (CPARS); therefore, at the time of award the contractor shall provide to the Contracting Officer a Point-of-Contract (POC) individual who will be responsible for managing reports within CPARS on this contract and will be assigned the role as “contractor representative” (CR) within CPARS.

CPARS is a Federal-agency wide system for the collection of Contractor Past Performance Information (PPI). Reporting PPI through CPARS is being implemented throughout VHA to be in compliance with the requirements of FAR Part 42 for documenting contractor performance assessments and evaluations.

PPI is relevant information for future source selection purposes regarding a contractor’s actions under previously awarded contracts. It includes, for example, the contractor’s record of conforming to contract requirements and to standards of good workmanship; the contractor’s record of forecasting and controlling costs; the contractor’s adherence to contract schedules, including the administrative aspects of performance; the contractor’s history of reasonable and cooperative behavior and commitment to customer satisfaction; the contractor’s record of integrity and business ethics, and, generally, the contractor’s business-like concern for the interest of the customer. Reporting PPI through CPARS facilitates compliance with the requirements of Office of Federal Procurement Policy (OFPP) memorandum, “Improving the Collection and Use of Information about Contractor Performance and Integrity”.

After award, the contractor’s CR will receive an email notification that access to the contract has been given to them. The CR should ensure that their contact information is accurate in CPARS at http://www.cpars.gov. The Contracting Officer/Contracting Officer Representative will evaluate the contractor's performance throughout the life of the contract, generally every 365 days, and at the end of contract performance. The report shall, then, be assigned in CPARS to the contractor's designated CR for comment.

The contractor’s CR will have up to 60 days to submit any comments and then re-assign the report to the VA Contracting Officer/contract specialist acting as the Assessing Official within CPARS. Failure to register and respond within the 60 days will result in the Government's evaluation being placed on file in the database with a statement that the contractor failed to respond. The contractor should note that the government’s evaluation will appear in the Past Performance Information Retrieval System (PPIRS) on day 15 in a pending status if the CR has not commented by day 15. After the CR has either commented or failed to respond within 60 days, the evaluation will become final in PPIRS.

It is the responsibility of the contractor to contact the contracting officer and request a change if, at any time, the contractor wishes to change the person assigned as the contractor representative on this contract.

Training in the use of CPARS is available online at https://www.cpars.gov by clicking on the tab “Training”.

INDIVIDUAL TO BE DESIGNATED AS CONTRACTOR REPRESENTATIVE (CR):

An individual must be designated in writing in order for a proposal to be considered responsive to the requirements of the applicable solicitation.

https://www.cpars.gov/

(First and last name):

Phone: Ext: Fax:

Email Address:

(End of Contractor’s Responsibility – CPARS)

SECTION C - CONTRACT CLAUSES

C.1 52.204-21 BASIC SAFEGUARDING OF COVERED CONTRACTOR

INFORMATION SYSTEMS (JUN 2016)

(a) Definitions. As used in this clause—

Covered contractor information system means an information system that is owned or operated by a contractor that processes, stores, or transmits Federal contract information.

Federal contract information means information, not intended for public release, that is provided by or generated for the Government under a contract to develop or deliver a product or service to the Government, but not including information provided by the Government to the public (such as on public Web sites) or simple transactional information, such as necessary to process payments.

Information means any communication or representation of knowledge such as facts, data, or opinions, in any medium or form, including textual, numerical, graphic, cartographic, narrative, or audiovisual (Committee on National Security Systems Instruction (CNSSI) 4009).

Information system means a discrete set of information resources organized for the collection, processing, maintenance, use, sharing, dissemination, or disposition of information (44 U.S.C. 3502).

Safeguarding means measures or controls that are prescribed to protect information systems.

(b) Safeguarding requirements and procedures. (1) The Contractor shall apply the following basic safeguarding requirements and procedures to protect covered contractor information systems. Requirements and procedures for basic safeguarding of covered contractor information systems shall include, at a minimum, the following security controls:

(i) Limit information system access to authorized users, processes acting on behalf of authorized users, or devices (including other information systems).

(ii) Limit information system access to the types of transactions and functions that authorized users are permitted to execute.

(iii) Verify and control/limit connections to and use of external information systems.

(iv) Control information posted or processed on publicly accessible information systems.

(v) Identify information system users, processes acting on behalf of users, or devices.

(vi) Authenticate (or verify) the identities of those users, processes, or devices, as a prerequisite to allowing access to organizational information systems.

(vii) Sanitize or destroy…