S02 36C26320R0125 - MEDICARE.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 82

36C26320R0125

Diana Rosier 651-293-3031

3:00PM CST

36C263 Department of Veterans Affairs

NETWORK 23 CONTRACTING OFFICE

Arlene Jorgensen Hillestad, CO 316 Robert Street N. STE. 506 St. Paul MN 55101

X

623110

$30 Million

N/A

X

Department of Veterans Affairs Network Contracting Office 316 Robert Street N Ste 506

St Paul MN 55101

Department of Veterans Affairs

NETWORK 23 CONTRACTING OFFICE

Attn: Diana Rosier , CS 316 Robert Street N. STE. 506 St. Paul MN 55101

Y

Department of Veterans Affairs Financial Services Center PO Box 149971

Austin TX 78714-9971

Under the Authority 38 U.S.C. 1720, This is a solicitation for NURSING HOME SERVICES in VISN 23 at VA.

Successful offerors will be awarded an Indefinite Delivery Indefinite Quantity (IDIQ) contract. Period of Performance is one 5-year ordering period with a possible 6-month extension.

The Government anticipates awarding multiple IDIQ contracts within VISN 23, for hospital sites that utilize MEDICARE as a basis for payment.

For a detailed list of requirements, listed by STATE and COUNTY, please see section E.1, Instructions to Offerors.

1358 payment process

X x 1

Arlene Jorgensen Hillestad Contracting Officer

03/05/2021

03/04/2022

X

36C26320R0125

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 NURSING HOME PERFORMANCE WORK STATEMENT (PWS) –

MEDICARE

NARA Records Management Language for Contracts (May 2017):

B. 3 SCHEDULE OF ITEMS – MEDICARE

SECTION C - CONTRACT CLAUSES

C.1 52.212-4 CONTRACT TERMS AND CONDITIONS—COMMERCIAL ITEMS (OCT

2018)

C.2 52.216-18 ORDERING (AUG 2020)

C.3 52.216-19 ORDER LIMITATIONS (OCT 1995)

C.4 52.216-22 INDEFINITE QUANTITY (OCT 1995)

C.5 52.217-8 OPTION TO EXTEND SERVICES (NOV 1999)

C.6 52.219-4 Notice of Price Evaluation Preference for HUBZone Small Business Concerns (DEVIATION 2019-01)

C.7 52.232-40 PROVIDING ACCELERATED PAYMENTS TO SMALL BUSINESS

SUBCONTRACTORS

C.8 VAAR 852.212-70 PROVISIONS AND CLAUSES APPLICABLE TO VA

ACQUISITION OF COMMERCIAL ITEMS (APR 2020)

C.9 VAAR 852.219-74 LIMITATIONS ON SUBCONTRACTING—MONITORING AND

COMPLIANCE (JUL 2018)

C.10 VAAR 852.216-71 ECONOMIC PRICE ADJUSTMENT OF CONTRACT PRICE(S)

BASED ON A PRICE INDEX (MAR 2018)

C.11 VAAR 852.219-75 SUBCONTRACTING COMMITMENTS MONITORING AND

COMPLIANCE (JUL 2018)

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

C.13 VAAR 852.252-70 SOLICITATION PROVISIONS OR CLAUSES

INCORPORATED BY REFERENCE (JAN 2008)

C.14 52.212-5 CONTRACT TERMS AND CONDITIONS REQUIRED TO IMPLEMENT

STATUTES OR EXECUTIVE ORDERS—COMMERCIAL ITEMS (NOV 2020)

C.15 MANDATORY WRITTEN DISCLOSURES

SECTION D - CONTRACT DOCUMENTS, EXHIBITS, OR ATTACHMENTS

See attached document: QASP - MEDICARE - FINAL.

See attached document: P07 WAGE DETERMINATION E-98 DECEMBER 21, 2020 - 1973- 0126, Rev. No. 64.

See attached document: WAGE DETERMINATION E98 - Wyoming - 1973-0130, REV. 60, DATE 12-21-2020.

See attached document: RUGs IV Levels of Care.

See attached document: S02 MEDICARE PRICING SCHEDULE - FINAL.

SECTION E - SOLICITATION PROVISIONS

E.1 52.212-1 INSTRUCTIONS TO OFFERORS—COMMERCIAL ITEMS (JUN 2020) 49

E.2 52.204-24 REPRESENTATION REGARDING CERTAIN TELECOMMUNICATIONS

AND VIDEO SURVEILLANCE SERVICES OR EQUIPMENT (OCT 2020)

E.3 52.209-7 INFORMATION REGARDING RESPONSIBILITY MATTERS (OCT 2018)

E.4 52.216-1 TYPE OF CONTRACT (APR 1984)

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

E.6 52.252-1 SOLICITATION PROVISIONS INCORPORATED BY REFERENCE (FEB

1998)

E.7 52.212-2 EVALUATION—COMMERCIAL ITEMS (OCT 2014)

E.8 52.212-3 OFFEROR REPRESENTATIONS AND CERTIFICATIONS—

COMMERCIAL ITEMS (NOV 2020)

SECTION B - CONTINUATION OF SF 1449 BLOCKS

B.1 CONTRACT ADMINISTRATION DATA

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

a. CONTRACTOR:

b. GOVERNMENT: Contracting Officer 36C263 Department of Veterans Affairs

NETWORK 23 CONTRACTING OFFICE

Diana Rosier, CS 316 Robert Street N. STE. 506 St. Paul MN 55101

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, in arrears

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 Requests.

Department of Veterans Affairs Financial Services Center PO Box 149971 Austin TX 78714-9971

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

AMENDMENT NO DATE

B.2 NURSING HOME PERFORMANCE WORK STATEMENT (PWS) –

MEDICARE

A. Overview

1. Federal Acquisition Regulation (FAR) – Indefinite Delivery Indefinite Quantity Contract (IDIQ). In accordance with FAR 16.504, Indefinite-Quantity Contracts, this is a IDIQ for the time period [from the “Award Date” for one (1) 5-year ordering period with a 6-month option to extend at the sole discretion of the Government].

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

3. Ordering. Orders MAY 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 and standard VA authorization at VA hospital sites (Reference FAR 16.505 (b)(2)(i)(B)). Ordering Officer Contact information is as follows:

Ordering Officer Name: TBD Address Telephone number E-mail address Facsimile number

None of the orders will be placed utilizing the fair opportunity process, because it has been determined that all orders will be subject to the relevant exceptions to the fair opportunity process.

The VA Ombudsman for task/delivery orders is the Associate Deputy Assistant Secretary (ADAS) for Procurement Policy, Systems, and Oversight (PPSO). The address and e-mail address for the Ombudsman follows:

Department of Veterans Affairs ADAS for Procurement Policy, Systems, and Oversight Risk Management and Compliance Service 810 Vermont Avenue, NW Washington, DC 20420 e-mail: VARiskManagement@va.gov

Note: Ordering officers MAY be authorized to place orders against this contract. The Contracting Officer will, if ordering officers are utilized, furnish the Contractor with the names of individuals authorized as ordering officers, by separate memorandum upon issuance of the contract. When ordering officers are added after award, the Contracting Officer will furnish the Contractor with the names of individuals authorized as ordering officers, by memorandum upon ordering officer appointment. Ordering officers are responsible for issuing and administering orders placed under this contract. Ordering officers have no authority to modify any term of this basic contract. Any deviation from the terms of the basic contract must be approved in writing by https://www.acquisition.gov/far/current/html/Subpart%2016_5.html#wp1095799 https://www.acquisition.gov/far/current/html/Subpart%2016_5.html#wp1095799 mailto:VARiskManagement@va.gov the Contracting Officer responsible for this contract. The Contractor shall accept orders against this contract only from the Contracting Officer and/or authorized ordering officers. Fulfilling orders from persons other than the Contracting Officer or ordering officer may result in loss or delay in payment for supplies/services provided under such orders.

4. Referrals to CNHs and placements. VA acknowledges that, depending on the availability of resources at specific IDIQ holder facilities at specific times, acceptance of a referral may be commercially impracticable for the IDIQ holder. Commercial or situational impracticability (e.g., facilities must be able to perform pre-admission screenings; assess whether the nursing home has beds open and appropriate beds; are able to meet care needs based on number of staff and possess the clinical expertise to manage veterans care; have the appropriate room (private or shared); can manage certain behaviors (like wandering if they don’t have a secure unit); and have the ability to decline based on criminal records, etc.). In that event, the IDIQ holder may decline to accept an authorization. If the IDIQ holder has determined that space is not available and will not accept the Veteran, the CNH program personnel will seek another IDIQ contract and an authorization will be issued when a match is found.

Designated CNH program personnel will issue written authorizations for Veterans to the IDIQ holder. In accordance with FAR 16.505(b)(2)(i)(A) or FAR 16.505(b)(2)(i)(B), VA has determined it is in the best interest of the Veteran to place the individual order without further competition because the need for these services is sometimes urgent, and providing the opportunity to all IDIQ holders or other vendors would result in unacceptable delays in fulfilling that need. Location primarily will be selected based on the Veteran’s needs and proximity to the Veteran’s home.

B. Background

1. 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 [Site] Health Care System, in [City, State] 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. 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 Veteran 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 Veterans. 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 and annual and ongoing quality reviews. 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. (The CNH also must be able to accept VA referrals within 24 hours of request). Primary care/provider (medical doctor, nurse practitioner, and/or physician assistant) visits will be available at the Medicare frequency requirements. Laboratory, x-ray, and other special services will be available to Veterans 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.

Authorized VA representatives will provide quality oversight visits to Veterans to assure satisfaction, quality, and continuity of care and may 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 IDIQ will include the cost of nursing care, room and board, meals, primary medical care which includes provider visits, drugs and routine supplies, laboratory, x-ray, and other special services authorized by VA, unless otherwise specifically excepted (see Schedule of Items in this IDIQ for details regarding per diem rates and coverage). Full attention shall be given to motivating and educating Veterans to achieve and maintain independence in the activities of daily living. Each Veteran must receive, and the facility must provide the necessary care and services to attain or maintain the highest practicable physical, mental and psychosocial well-being, in accordance with the comprehensive assessment and plan of care.

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 Veterans from the CNH at any time when it is determined to be in the best interest of VA or the Veterans without additional costs to the Government.

3. VA Authorizations. Authorization for nursing home care will be submitted as a standard VA authorization. Each authorization validity period will be noted on the order with a beginning and end date. Any extension to the original authorization validity period, regardless of the number of days, requires a new authorization.

NOTE: During the time period of this contract, the Medicare payment method below MAY change to Patient Driven Patient Method (PDPM) or another system. See, also, Schedule of Items in section B.3 of this contract.

4. Medicare-Based Rates. The Resource Utilization Grouping (RUG) rate(s) will include the cost of medical care, medications, laboratory, x-ray, therapy (ies), and other special services authorized by VA, unless otherwise specifically exempted (Refer to Table A in the schedule of items). VA will contract for appropriate Medicare categories of care using Resource Utilization Groups (RUGs-IV) as a reference. A description of the RUGs-IV systems can be found in 42 CFR Parts 409, et al.

5. Medicare Rate Determination. The per diem rate is determined by the Medicare based approved rates including the cost of supplies, services, and equipment that is provided under Medicare. Rates established after the Effective Date of this IDIQ will require a modification to the IDIQ. The RUGS IV rates include room, board, and routine nursing care, rehabilitation therapy (including physical, speech and occupational therapy), respiratory therapy, oxygen therapy, medical and nursing supplies (including items such as urological and colostomy supplies), most oral medications, most items of durable medical equipment (excluding ventilators), x-rays, and routine laboratory tests (see Schedule of Items in this IDIQ for details on rates). Any additional requests for payment to the all-inclusive per diem rates must be pre-approved.

6. The CNH’s Minimum Data Set (MDS) Assessment for Medicare: The CNH’s Minimum Data Set (MDS) assessment will be completed on the same schedule as the current Medicare MDS-Scheduled assessments, including start of therapy (SOT) and end of therapy (EOT) assessments. Classification changes will be approved by VA, adhering to the most current MDS frequency guidelines from Medicare. The applicable per diem rate will continue until the next assessment. The RUG scores should be submitted on the MDS software that generates the RUG (usually section Z) or on a Level of Care Authorization Form provided to the CNH.

7. 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 Veteran care; arranging easy access to staff for consultation; providing timely response to calls and arranging for timely provider back-up according to the Omnibus Budget Reconciliation Act (OBRA), also known as the Nursing Home Reform Act of 1987, guidelines (42 CFR 483.30, OBRA Guidelines).

8. Rehabilitation Criteria. All therapy provided will be individual therapy, rather than group therapy, unless otherwise ordered by the authorizing VA facility. Therapy evaluation must be completed and sent to the VA CNH office for approval of services. 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.

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 Veteran’s disability or dysfunction and designed to specifically address each problem identified in the evaluation;

design of a plan of care addressing the Veteran’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 Veteran and family training to augment rehabilitative treatment or establish a maintenance program. Education of staff and family should be ongoing.

9. 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 Medical Center (VA) 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.

10. 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.

11. 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 [SITE] Home and Community Care Department at [PHONE #]. VA will monitor the professional care and administrative management of services provided to VA beneficiaries, 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 Veterans. 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, 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.

12. 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 annual reviews. The CNH will develop in the time period specified by VA timely and appropriate CAPs for VA annual reviews 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.

13. Re-admission to the VA Hospital and Emergency Care; Notification of Death of Veterans; CNH Responsibility to Veteran’s Belongings or Personal Effects. VA beneficiaries who begin to require more than the level of care authorized by VA will be readmitted to an appropriate VA Medical Center (VA), 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 Veteran to a non-Federal facility. If hospitalization of a non-emergency nature is required, readmission to a VA Medical Center may be accomplished as soon as the Veteran’s condition is sufficiently stabilized to permit admission to a VA.

b. In the event of a death of a VA beneficiary, while receiving nursing home care, the CNH will promptly notify the VA facility which authorized admission and immediately assemble, inventory, and safeguard the Veteran’s personal effects. The funds, deposits, and effects left by the VA Veterans 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 Veterans, unless the beneficiary died without leaving a will, heirs or next of kin capable of inheriting.

c. Should a deceased Veteran 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 itemized inventory with annotation as to the disposition of the funds and effects of any such property and funds in its possession to the VA facility of jurisdiction 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 nursing home records for five (5) years when there is no requirement in State law.

14. Bed-Hold Policy for hospitalizations and approved therapeutic passes.

Hospitalizations do not require a pre-authorization, but VA must be notified as soon as possible (no later than one business day after hospitalization). Therapeutic passes are to be limited and pre-authorized by the VA.

a. HOSPITALIZATIONS

The first two days of hospitalization reimbursed at 70% of the current per diem rate.

b. THERAPEUTIC PASSES (pre-authorized only)

Two days per month, reimbursed at 70% of the current per diem rate, if prior authorization is received from the local VA.

Bed-hold begins the date the Veteran departs the CNH and the current per diem rate resumes the date of readmission. Absences of fifteen (15) consecutive days requires the VA to discharge the Veteran from the current CNH authorization. A new authorization is required upon readmission to a CNH. The CNH is responsible to notify the Veteran / family of any financial responsibility for bed hold days not paid by the VA, arrangements may then be made between the Veteran / family and the CNH beyond the VA authorized (two) days.

15. Reportable Events (QASP Indicator #3). 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: 1) sentinel events; 2) substantiated allegations of mistreatment, neglect, abuse or misappropriation of CNH Veterans or property; 3) elopements of CNH Veterans pursuant to state regulations; 4) infectious outbreaks; 5) resident to resident or resident to staff altercations involving a CNH Veteran resulting in any injury that is other than minor; 6) copies of annual surveys or substantiated complaint investigations conducted by a State oversight agency; and 7) adverse events. Reporting shall be in writing and include date of occurrence and Veteran disposition and outcome. Other Reportable Events that should be reported timely, but not necessarily immediately are: 1) when there is a change of nursing home administrator or Director of Nursing/Director of Nursing Service; or 2) when there is a pending change of ownership of the CNH.

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 resident; 3) resident abuse confirmed or under suspicion; 4) a medication error resulting in resident illness or injury; 5) death or resident 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.

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:

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.

17. VA Staff Access to CNH Records (QASP Indicator #4). All medical records concerning the Veteran’s care in the CNH will be readily accessible to VA. Upon discharge or the death of a Veteran, medical records will be retained by the CNH for a period of at least five

(5) years following termination of care. Veteran records will be maintained in conformance with the Privacy Act of 1974 (5 U.S.C. § 552a). VA will have remote access to records for offsite review. A medical record shall be maintained for each Veteran, which includes at least the following:

a. VA 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.

b. Copy of authorization.

c. 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 IDIQ with the CNH;

3. The plan of care and services including medication administration, provided by

CNH staff and services provided under the IDIQ 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.

d. 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 or ophthalmology).

[THE FOLLOWING PARAGRAPH SHOULD BE TAILORED FOR EACH SITE]

19. VA Medical Center Consultation/Resources.

(a) Telephone Care Communications Systems (TCCS): For urgent same-day outpatient specialty care or for non-urgent scheduled clinic appointments/consultations, [PHONE #] 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) Admissions Conference Call System phone number: [PHONE #].

For non-emergency consultation or /evaluation for admission to the [FACILITY/SITE NAME] (after initial evaluation or intervention by the nursing home physician).

(c) After hours, weekends and holidays: For urgent referrals or consultation contact the Admission Conference Call System number [PHONE #].

(d) Transportation: Necessary transportation to and from the VA hospital for clinics, evaluation or hospitalization will be arranged and MAY BE paid by the VA hospital for CNH patients when requested. For clinic appointments, call O[PHONE #].

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

21. CNH Billing. Invoices for board, care and ancillary services shall be submitted promptly to the authorizing facility after generation of Medicare RAI/MDS RUG Scores and not later than 30 days following the end of the month in which services were rendered. The CNH will promptly notify the VA CNH program 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 Veteran’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 whenever it is found that the original invoice was not correct. All corrected invoices must include all items that are affected by the change.

22. Minimum Quantities; VA Payment. It is impossible to determine the exact or estimated amount, which will be expended under this IDIQ. Only the minimum guarantee obligation will be incurred by VA under this IDIQ, 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 IDIQ. VA will make payment for the day a Veteran enters the CNH but not the day the Veteran leaves a CNH unless entrance and departure are on the same day, then payment will be made for one (1) day.

23. VA Payments. Payments made by VA under any contract pursuant to this IDIQ, 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 is obtained from the VA facility authorizing placement. The Veteran, 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. Should Veteran / family choose to have a service not authorized by VA, i.e. private room when double room available or therapy when VA has reviewed and deemed not medically indicated, the CNH will first contact VA to insure the service is not covered by VA, then make arrangements with Veteran / family for private pay. Invoicing will be conducted electronically.

The contractor, their personnel, and their subcontractors shall be subject to the Federal laws, regulations, standards, and VA Directives and Handbooks regarding information and information system security as delineated in this contract.

NARA Records Management Language for Contracts (May 2017):

https://www.archives.gov/records-mgmt/handbook/records-mgmt-language.html

1. Contractor shall comply with all applicable records management laws and regulations, as well as National Archives and Records Administration (NARA) records policies, including but not limited to the Federal Records Act (44 U.S.C. chapters 21, 29, 31, 33), NARA regulations at 36 CFR Chapter XII Subchapter B, and those policies associated with the safeguarding of records covered by the Privacy Act of 1974 (5 U.S.C. 552a). These policies include the preservation of all records, regardless of form or characteristics, mode of transmission, or state of completion.

2. In accordance with 36 CFR 1222.32, all data created for Government use and delivered to, or falling under the legal control of, the Government are Federal records subject to the provisions of 44 U.S.C.

chapters 21, 29, 31, and 33, the Freedom of Information Act (FOIA) (5 U.S.C. 552), as amended, and the Privacy Act of 1974 (5 U.S.C. 552a), as amended and must be managed and scheduled for disposition only as permitted by statute or regulation.

3. In accordance with 36 CFR 1222.32, Contractor shall maintain all records created for Government use or created in the course of performing the contract and/or delivered to, or under the legal control of the Government and must be managed in accordance with Federal law. Electronic records and associated metadata must be accompanied by sufficient technical documentation to permit understanding and use of the records and data.

4. [VA _______ Health Care System] and its contractors are responsible for preventing the alienation or unauthorized destruction of records, including all forms of mutilation. Records may not be removed from the legal custody of [VA _____ Health Care System] or destroyed except for in accordance with the provisions of the agency records schedules and with the written concurrence of the Head of the Contracting Activity. Willful and unlawful destruction, damage or alienation of Federal records is subject to the fines and penalties imposed by 18 U.S.C. 2701.

In the event of any unlawful or accidental removal, defacing, alteration, or destruction of records, Contractor must report to [VA _____ Health Care System]. The agency must report promptly to NARA in accordance with 36 CFR 1230.

5. The Contractor shall immediately notify the appropriate Contracting Officer upon discovery of any inadvertent or unauthorized disclosures of information, data, documentary materials, records or equipment. Disclosure of non-public information is limited to authorized personnel with a need-to-know as described in the [contract vehicle]. The Contractor shall ensure that the appropriate personnel, administrative, technical, and physical safeguards are established to ensure the security and confidentiality of this information, data, documentary material, records and/or equipment is properly protected. The Contractor shall not remove material from Government facilities or systems, or facilities or systems operated or maintained on the Government’s behalf, without the express written permission of the Head of the Contracting Activity. When information, data, documentary material, records and/or equipment is no longer required, it shall be returned to [VA ______ Health Care System] control or the Contractor must hold it until otherwise directed. Items returned to the Government shall be hand carried, mailed, emailed, or securely electronically transmitted to the Contracting Officer or address prescribed in the [contract vehicle]. Destruction of records is EXPRESSLY PROHIBITED unless in accordance with Paragraph (4).

6. The Contractor is required to obtain the Contracting Officer's approval prior to engaging in any contractual relationship (sub-contractor) in support of this contract requiring the disclosure of information, documentary material and/or records generated under, or relating to, contracts. The Contractor (and any sub-contractor) is required to abide by Government and [VA ______ Health Care https://www.archives.gov/records-mgmt/handbook/records-mgmt-language.html

System] guidance for protecting sensitive, proprietary information, classified, and controlled unclassified information.

7. The Contractor shall only use Government IT equipment for purposes specifically tied to or authorized by the contract and in accordance with [VA ______ Health Care System] policy.

8. The Contractor shall not create or maintain any records containing any non-public [VA _____ Health Care System] information that are not specifically tied to or authorized by the contract.

9. The Contractor shall not retain, use, sell, or disseminate copies of any deliverable that contains information covered by the Privacy Act of 1974 or that which is generally protected from public disclosure by an exemption to the Freedom of Information Act.

10. The [VA ______ Health Care System] owns the rights to all data and records produced as part of this contract. All deliverables under the contract are the property of the U.S. Government for which [VA _____ Health Care System] shall have unlimited rights to use, dispose of, or disclose such data contained therein as it determines to be in the public interest. Any Contractor rights in the data or deliverables must be identified as required by FAR 52.227-11 through FAR 52.227-20.

11. Training. All Contractor employees assigned to this contract who create, work with, or otherwise handle records are required to take VHA-provided records management training. The Contractor is responsible for confirming training has been completed according to agency policies, including initial training and any annual or refresher training.

END PERFORMANCE WORK STATEMENT

B. 3 SCHEDULE OF ITEMS – MEDICARE

1. Rate Determination: The VA is seeking preferred rates, based on patient care need. VA rates are an all -inclusive per diem rate. Items generally included or excluded in the per diem rate are listed in Table A, although some variances may apply in coverage. The per diem rate(s) will apply throughout the term of this Indefinite Quantity Contract (IDIQ).

NOTE: During the time period of this contract, the Medicare payment method MAY change to the Patient Driven Payment Model (PDPM) or another system. However, until further notice , VA pricing will be based on rates published in the Federal Register, August 8, 2018, p. 39162 (as calculated directly below in 2018) and as increased yearly by a percentage determined by

VA.

2. Rate Adjustments: Rate adjustments are made in accordance with the proper federal regulatory standard and in accordance with the IDIQ as mutually agreed upon by both parties.

Rate adjustments are not effective until the IDIQ modification is 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 IDIQ or the modification. Throughout the term of the contract, the VA will adjust the Medicare Base Rate in accordance with the EPA clause incorporated into the contract (852.216-71). Any adjustments made to the Medicare Base Rate will be calculated in the same manner as the original rate determination (i.e., “Federal Rates – Labor” X “Wage Index” = “Adjusted Labor” + “Federal Rates – Non‐Labor” = “Medicare Base Rate”).

3. Rate Calculation Example:

(1) The original line item prices for that contract term (Fiscal Year) shall be used for all calculations during that particular contract term and new calculations shall be made for each and every contract adjustment period (Fiscal Year) during that contract term.

The Medicare Per Diem Rate, which is the rate that the VA should be billed, is calculated by subtracting the percentage discount from the Medicare Base Rate.

The Medicare Base Rate is calculated based on information provided by the Centers for Medicare & Medicaid Services, as published in the Federal Register and on the CMS website.

Specifically, the “Federal Rates – Labor” X “Wage Index” = “Adjusted Labor” + “Federal Rates

– Non‐Labor” = “Medicare Base Rate”. (The wage index used in the calculation depends on the location of the nursing home (i.e., state, county, and urban/non-urban county). So, for a nursing home that is located in an urban county within any State, the following example represents the calculation of the Medicare Base Rate.

(2) For purposes of this example, the contract prices for the line items will be adjusted by the percentage calculated as follows:

RUG-IV Category-URBAN: RUX:

Federal Rates – Labor $575.75

Wage Index 1.1295

Adjusted Labor $650.31

Federal Rates – Non-Labor $237.45

Medicare Base Rate: $887.76

Negotiated discount of 15% $133.16

RUX price for this nursing home facility is: $754.60

The “Federal Rates – Labor” X “Wage Index” = “Adjusted Labor” + “Federal Rates – Non-Labor” = “Adjusted Rate Total” - (“Negotiated discount %” X “Medicare Base Rate”) will be the cost of the RUX for this nursing home.

This information is taken from TABLES in the Federal Register and the Wage Index is on the CMS website.

TABLES from the Federal Register.

1. RUG-IV Case-Mix adjusted Federal rates for URBAN SNF’s by Labor and Non-Labor component

2. RUG-IV Case-Mix adjusted Federal rates for RURAL SNF’s by Labor and Non-Labor component

CMS Website: www.cms.gov. The direct link for the wage indexes is:

http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/SNFPPS/WageIndex.html.

The excel spreadsheet has two tabs on the bottom. One tab is for Urban Wage indexes, the other tab is for Non-Urban Wage Indexes. They are listed by state.

There are three (3) areas of general information needed to determine which Wage Index to use:

1. Which State is the facility in?

2. Which County is the facility in?

3. Is that County Urban or Non-Urban (Rural)?

The Urban Wage Index was used to calculate in the Example above.

http://www.cms.gov/ http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/SNFPPS/WageIndex.html

Table A

SERVICE COVERED

BY PER-

DIEM

NOT

COVERED

BY PER

DIEM

NOTES

Room and Board X

Routine nursing care X

Physical Therapy X Pre-approval required (Paragraph 3) of this Schedule of Items

Occupational Therapy X Pre-approval required(Paragraph 3) of this Schedule of Items

Speech Therapy X Pre-approval required(Paragraph 3) of this Schedule of Items

Respiratory Therapy X

Oxygen Therapy X

Provider visits

(MD/NP)

1 per month Pre-approval required for additional visits

Routine Podiatry Care X

Nursing supplies X

Medications X Paragraph 4 of this Schedule of Items

Durable medical Equipment

X Can be obtained through VA

Radiology Studies X

Lab Tests X

Specialized beds X Pre-approval and special authorization required of this Schedule of Items

Hospice Care X Veterans may be eligible for additional hospice program services, but must be separately authorized by VA.

Dialysis X Pre-approval and special authorization required of this Schedule of Items

Transportation X Pre-approval and special authorization required of this Schedule of Items

UC/ER visits X Refer to Performance Work Statement (PWS) sections 9 and 16(a)

Hospitalizations X Refer to Performance Work Statement (PWS) section 16(a)

Psychology Services X Pre-approval and special authorization required of this Schedule of Items

Social Services X

Therapeutic Recreational services

X

Pastoral Care X

Laundry/Linen service X

TPN/IV Therapy X Pre-approval and special authorization required of this Schedule of Items

Dental Care X Pre-approval and special authorization required of this Schedule of Items

Audiology Care X Pre-approval and special authorization required of this Schedule of Items

Eye Care X Pre-approval and special authorization required of this Schedule of Items

Custom Prosthetics X Pre-approval and special authorization required of this Schedule of Items

Specialized Wound Care

X Pre-approval and special authorization required of this Schedule of Items

Private Room X See Paragraph 5 of this Schedule of Items

Ventilator Care X See Paragraph 6 of this Schedule of Items

4. 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.

5. Medications: All Medications administered to VA-contracted Veterans residing in a CNH will be charged according to Average Warehouse Price (AWP) or the State Medicaid rate…