S02 - RFQ 36C25622Q0214 v1.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. NOV 2021)

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

7. FOR SOLICITATION

INFORMATION CALL:

STANDARD FORM 1449

SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL PRODUCTS AND COMMERCIAL SERVICES

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

36C25622Q0214 04-05-2022

Stephanie Keo 713-791-1414 04-04-2023

15:00 CST

36C256

Department of Veterans Affairs

Network Contracting Office 16

Michael E. DeBakey VA Medical Center

2002 Holcombe Boulevard

Houston TX 77030 4298

X

623110

$30 Million

N/A

36C580

Department of Veterans Affairs

Michael E. DeBakey VA Medical Center

Receiving Warehouse Building 100

2002 Holcombe Boulevard

Houston TX 77030-4298

36C256

Department of Veterans Affairs

Network Contracting Office 16

Michael E. DeBakey VA Medical Center

2002 Holcombe Boulevard

Houston TX 77030 4298

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

Invoice Setup Information 1-877-489-6135

Invoice must be submitted electronically

Setup 1-877-489-6135 512-460-5429

Contractor to provide Community Nursing Home (CHN) Services for the Department of Veterans Affairs Michael E. DeBakey

VA Medical Center (MEDVAMC) Angelina, Brazoria, Fort Bend, Galveston, Harris, Jefferson, Montgomery, Walker County catchment area. catchment area. For additional information information reference Schedule of Services and Performance

Work Statement on page 6 through 28.

NOTIFICATION TO OFFEROR:

Offerors must complete and return all information designated in section D (Page 53) prior to the time specified in block of SF 1449 (Page 1) in order to be considered for award.

Required documents and instructions for proposal submission are on page 58 through page 59 - INSTRUCTIONS TO OFFERORS

FOR PROPOSAL SUBMISSION ADDENDUM TO FAR 52.212-1.

This is a multiple award solicitation in accordance with

Federal Acquisition Regulation(FAR) 12,13,13.5, and 16.504.

x 1(one)

Stephanie Keo

VA-VHA-2020-49890DD7

36C25622Q0214

Table of Contents

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

COMMERCIAL SERVICES

SECTION B - CONTINUATION OF SF 1449 BLOCKS

B.1 CONTRACT ADMINISTRATION DATA

B. 2 SCHEDULE OF ITEMS/PRICE COST SCHEDULE

B.3 PERFORMANCE WORK STATEMENT (PWS)

SECTION C - CONTRACT CLAUSES

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

AND COMMERCIAL SERVICES (NOV 2021)

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

C.3 52.204-21 BASIC SAFEGUARDING OF COVERED CONTRACTOR INFORMATION

SYSTEMS (NOV 2021)

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 52.217-8 OPTION TO EXTEND SERVICES (NOV 1999)

C.8 52.232-19 AVAILABILITY OF FUNDS FOR THE NEXT FISCAL YEAR (APR 1984) 38

C.9 VAAR 852.212-70 PROVISIONS AND CLAUSES APPLICABLE TO VA

ACQUISITION OF COMMERCIAL ITEMS (APR 2020)

C.10 VAAR 852.219-75 SUBCONTRACTING COMMITMENTS MONITORING AND

COMPLIANCE (JUL 2018)

C.11 VAAR 852.222-70 CONTRACT WORK-HOURS AND SAFETY STANDARDS—

NURSING HOME CARE FOR VETERANS (MAY 2018)

C.12 VAAR 852.237-70 INDEMNIFICATION AND MEDICAL LIABILITY INSURANCE

(OCT 2019)

C.13 VAAR 852.219-76 SUBCONTRACTING PLANS MONITORING AND COMPLIANCE

(JUL 2018)

C.14 VAAR 852.219-9 VA SMALL BUSINESS SUBCONTRACTING PLAN MINIMUM

REQUIREMENTS (DEC 2009)

C.15 VAAR 852.219-71 VA MENTOR-PROTÉGÉ PROGRAM (DEC 2009)

C.16 52.212-5 CONTRACT TERMS AND CONDITIONS REQUIRED TO IMPLEMENT

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

(DEVIATION)

SECTION D - CONTRACT DOCUMENTS, EXHIBITS, OR ATTACHMENTS

D.1 QUALITY ASSURANCE SURVEILLANCE PLAN (QASP)

D.2 DEPARTMENT OF VETERANS AFFAIRS (VA) COMMUNITY NURSING HOME

PROGRAM LEVEL OF CARE – DESCRIPTIONS RUG IV

D.3 TECHNICAL CAPABILITY CHECKLIST (TECHNICAL QUOTE)

D.4 SMALL BUSINESS SUBCONTRACTING PLAN/CERTIFICATION

D.5 SERVICE CONTRACT ACT WAGE DETERMINATION

SECTION E - SOLICITATION PROVISIONS

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

COMMERCIAL SERVICES (NOV 2021)

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

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

1998)

E.3 52.204-24 REPRESENTATION REGARDING CERTAIN TELECOMMUNICATIONS

AND VIDEO SURVEILLANCE SERVICES OR EQUIPMENT (NOV 2021)

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

E.5 52.216-1 TYPE OF CONTRACT (APR 1984)

E.6 52.233-2 SERVICE OF PROTEST (SEP 2006)

E.7 VAAR 852.233-70 PROTEST CONTENT/ALTERNATIVE DISPUTE RESOLUTION

(OCT 2018)

E.8 EVALUATION—COMMERCIAL ITEMS (ADDENDUM)

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

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

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:

b. GOVERNMENT: Stephanie Keo, Contracting Officer 36C256

Department of Veterans Affairs

Network Contracting Office 16

Galleria Financial Center

5075 Westheimer Road, Suite 750

Houston, TX 77056

Phone: 713-791-1414 ext. 26408

Email: stephanie.keo@va.gov

Contracting Officer Representative (COR):

JoAnn Bonds, Registered Nurse, Community Nursing Home Coordinator

Department of Veterans Affair

Michael E. DeBakey VA Medical Center

2002 Holcombe Boulevard

Houston, TX 77030-4298

Phone: 713-791-1414 ext.25838

Email: joann.bonds@va.gov

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

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

[] 52.232-36, Payment by Third Party

3. INVOICES: Invoices shall be submitted in arrears:

a. Quarterly []

b. Semi-Annually []

c. Other [x] Monthly in Arrears

Point of Contact (POC)/Title: __________________________________

Address: __________________________________

Phone: __________________________________

Email: __________________________________

DUNS Number: __________________________________

Tax ID: __________________________________ mailto:stephanie.keo@va.gov mailto:joann.bonds@va.gov

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

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

Invoice Setup Information 1-877-489-6135

Invoice must be submitted electronically

5. SECURE FAX: Please review VA Handbook 6500 that requires the following statement on all fax cover sheets be included: This fax is intended only for the use of the person or office to which it is addressed and may contain information that is privileged, confidential, or protected by law. All others are hereby notified that the receipt of this fax does not waive any applicable privilege or exemption for disclosure and that any dissemination, distribution, or copying of this communication is prohibited. If you have received this fax in error, please notify this office immediately at the telephone number listed above.

6. Mandatory written disclosures required by FAR clause 52.203-13 to the Department of Veterans

Affairs, Office of Inspector General (OIG) must be made electronically through the VA OIG Hotline at https://www.va.gov/oig/hotline/ and clicking on "FAR clause 52.203-13 Reporting." If you experience difficulty accessing the website, call the Hotline at 1-800-488-8244 for further instructions.

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

AMENDMENT NO DATE

(End of B.1 Contract Administration Data) http://www.fsc.va.gov/fsc/einvoice.asp https://www.va.gov/oig/hotline/

B. 2 SCHEDULE OF ITEMS/PRICE COST SCHEDULE

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

Indefinite Quantity (IDIQ) contract. 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 IDIQ contract. The per diem rate utilizes the Medicaid Resident Assessment Instructions (RAI)/Minimum Data Set (MDS) assessment and RUGS score as the reference for rates. Assessment schedules identical to Medicaid 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 can be requested by either the VA or an authorized Community

Nursing Home (CNH) representative of the Contractor during the term of this IDIQ contract. Request for

Rate adjustments must be accompanied by a justification for consideration by the Contracting Officer. If approved, the IDIQ contract must be modified and signed by both the Contractor and the VA Contracting

Officer. Rate adjustments are not effective until the IDIQ contract 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 contract 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. Therapy must be ordered by a VA physician for a specific period of time, not to exceed one month. Orders may be recertified. A copy of the therapy notes will be sent to the VA facility each month.

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.

8. Ancillary Services: Ancillary services costs are pre-approved costs for supplies or services not identified as included in the all-inclusive rate or any other pre-authorized rate or schedule or payment for items or services provided under this contract. Ancillary costs such as medications, patient escort services and special equipment, may not be added to any invoice without written permission of the VA medical center placing the Veteran. If permission is received, the nursing home must also submit the physician's order for the medication/supply, the dispensing log, the supplier and the cost charged by the supplier to the nursing home, and what the nursing home is charging the VA.

9. Economic Price Adjustment: This does not apply to ancillary services that may be added or deleted from the contract. Reference VAAR clauses 852.216-73 and 852.216-74 for additional information on

Economic Price Adjustments in section C.

The per diem rate(s) will apply throughout the term of this contract, including extension period(s). The rate(s) may be adjusted only to reflect a change in a Medicaid rate as authorized by the State Medicaid

Agency (SMA). Normally, this will be on an annual basis. The negotiated percentage above the

Medicaid rate, to cover the all-inclusive nature of the contract, will not be renegotiated; but will be applied and added to the new Medicaid rate for the adjusted per diem rate for each level of care item.

This clause does not apply to rates for non-Medicaid nursing homes. In this regard, new rates will be negotiated requiring a modification to the contract. Each per diem price adjustment under this clause is subject to the following limitations:

Any adjustment shall be limited to the effect of increases or decreases in the approved SMA's patient care components within the affected Medicaid groups. Nursing home officials shall notify the Contracting

Officer within 10 days after this occurs to confirms their facility level and based on the approved facility

Enhancement level set by the State of Texas SMA. The contract number issued by the State of Texas is verified against SMA's website. The CNH's base RUGs posted on SMA's website will be used to verify the CNH's published rate by the state with sub RUG categories.

Adjustments will occur no more frequently than those issued by the SMA.

10. Minimum Quantities: It is impossible to determine the exact or estimated amount which will be expended under this contract. No obligation will be incurred by VA under this contract until authorizations are issued for CNH 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 Performance Work Statement of this contract. VA will make payment for the day a recipient enters the facility but not the day the recipient leaves a facility unless entrance and departure are on the same day then payment will be made for one (1) day.

Note: 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 at the VA’s discretion.

11. PERIOD OF PERFORMANCE (Ordering Period): This is a multiple award IDIQ solicitation, based on the Government’s needs. More than one contractor maybe awarded an IDIQ contract from this solicitation. Listed below are ordering periods that may be awarded to a contractor based on the

Government’s needs. Depending on the Government’s needs, contractor may be awarded one of the five listed below ordering periods:

- One (1) year (12 Months) ordering period from the date of award.

- Two (2) year (24 Months) ordering period from the date of award.

- Three (3) year (36 Months) ordering period from the date of award.

- Four (4) year (48 Months) ordering period from the date of award.

- Five (5) year (60 Months) ordering period from the date of award.

** The Government may choose to do an ordering period not listed above not to exceed a Five (5) year period if it is determined to be in the best interest of the Government.

**Note** Task orders issued from the awarded IDIQ contract to provide CNH services will be issued for a period of performance at the discretion of the Government.

LEVEL OF CARE: _______________

MEDICAID RATE+ PERCENTAGE RATE = PER DIEM RATE (All-Inclusive Per Diem Rate)

RUG CATEGORIES

CONVERSION RUG

LEVEL

MEDICAID RUG

RATES

PLUS PERCENTAGE

RATE

ALL-INCLUSIVE

PER DIEM RATE

REHABILITATION +

EXSTENSIVE SERVICES

SE3+Rehabilitation RUX $ $

SE2+Rehabilitation RUL $

SE1+Rehabilitation RVX $ $

REHABILITATION

RAD RUA $ $

RAC RMC $ $

RAB RUB $ $

RAA RVA $ $

EXTENSIVE SERVICES

SE3 ES3 $ $

SE2 ES2 $ $

SE1 ES1 $

SPECIAL CARE

SSC HE1 $ $

SSB HE2 $

SSA HD1 $

CLINICALLY COMPLEX

CC2 CC2 $

CC1 CC1 $

CB2 CB2 $ $

CB1 CB1 $ $

CA2 CA2 $

CA1 CA1 $ $

REDUCED PHYSICAL,

BEHAVIOR & COGNITIVE

PERFORMANCE

IB2 LB2 $

IB1 LB1 $ $

IA2 LC1 $ $

IA1 LC2 $ $

BB2 BB2 $

BB1 BB1 $ $

BA2 BA2 $ $

BA1 BA1 $

PE2 PE2 $ $

PE1 PE1 $ $

PD2 PD2 $ $

PD1 PD2 $ $

PC2 PC2 $ $

PC1 PC2 $ $

PB2 PB2 $ $

PB1 PA1 $ $

PA2 PA2 $ $

PA1 PA1 $ $

BC1 PA1 $ $

PCE PA1* $ $

*Reduced Physical

Functioning or no MDS

Patient Escort Services: Contractor shall provide patient escort services as identified in the Performance

Work Statement (PWS) on a as needed basis. Patient escort services shall not exceed the amount of

$8,680.00 per year and be billed on an hourly basis. Reference section for additional information 19 (d) for additional details.

All Inclusive VA Per Diem Rates include the following: Drugs, Supplies, Oxygen, X-Ray, Laboratory, Physicians visits, Respiratory Therapies, and Rental Equipment.

Minimum Quantity (Guaranteed Minimum): One (1) Veteran minimum guarantee during the life of the

IDIQ contract in the total amount of $1,000.00.

Maximum Quantity: Twenty (20) Veterans Total at one time for the life of the IDIQ contract.

Six (6) Month Extension: As indicated in FAR 52.217-8 the Government will have the option provision to extend the performance of the contract up to an additional six (6) months when the contractor is provided written notice. Six (6) month extension will be based on Medicaid rates and the percentage from the final ordering period. Thus, providing separate pricing (percentage) for the optional six-month extension period is not required.

Prior to exercising the six (6) month extension, (1) the Contracting Officer will ensure that it is still in the

Government’s best interest, with price and other factors considered, and (2) the options do not extend beyond the period of the Schedule contract.

Table A (All Inclusive VA PER DIEM)

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 Visit

(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 for 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 for this

Schedule of Items

Patient Escort Services X For patient escort services. Refer to

PWS section 19 d. Pre-approval required by VA

Specialized

Transportation

X Appointments for Dental, Respiratory, XRT, Renal, and

Wound Clinic. Refer to PWS section

19 d. Pre-approval required for additional visits

UC/ER X Refer to PWS section 2.1.12

Psychology Services X Pre-approval and special authorization required for 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 for this

Schedule of Items

Dental Care X Pre-approval and special authorization required for this

Schedule of Items

Audiology Care X Pre-approval and special authorization required for this

Schedule of Items

Eye Care X Pre-approval and special authorization required for this

Schedule of Items

Custom Prosthetics X Pre-approval and special authorization required for this

Schedule of Items

Specialized Wound

Care

X Pre-approval and special authorization required for 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

(End of B. 2 Schedule of Items/Price Cost Schedule)

B.3 PERFORMANCE WORK STATEMENT (PWS)

1. Federal Acquisition Regulation (FAR) – Indefinite Delivery Contract (IDC). In accordance with FAR 16.504, Indefinite-Quantity Contracts, this is an Indefinite Delivery, Indefinite Quantity (IDIQ) contract and will be referred to as IDC that will be solicited to multiple contractors for award. There will be multiple ordering periods based on the needs of the Government. Reference page 8, section labeled

“PERIOD OF PERFORMANCE (Ordering Period)” for multiple ordering periods that may be awarded on the Government’s needs (**Note** this section will be revised on the final contract documents to reflect the actual ordering period of the awarded contract).

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.2 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 Officer or Contracting Officer Representative

(COR) 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 or COR Name: Joann Bonds

Address 2002 Holcombe Blvd

Telephone number 713-578-5838

E-mail address Joann.bonds@va.gov

Facsimile number 713-794-7014

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

A. 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 Michael E. DeBakey Medical Center Health Care System, in Houston, Texas

Texas 77030 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.

B. 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 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 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:

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

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 require preapproval by VA before services are provided. Therapy must be skilled, relate to safety and 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 http://www.va.gov/vhapublications/publications.cfm?pub=2 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. 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 VA RN Coordinator at VA Home and

Community Care Department at 713-794-7469. 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% sprinkled;

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

When deemed appropriate, VA will reimburse the CNH 70% of applicable per diem rate for bed hold not to exceed two (2) days per episode, four (4) days total per month.

Bed-hold will begin the date the resident leaves the CNH and full per diem will resume on the date of readmission to the CNH. Absences of fifteen (15) consecutive calendar days or more, whether in a VA or in a non-Federal facility require a new authorization agreement. The nursing home is responsible to notify the family if a bed hold is required for a longer period. The family would then make arrangements with the home to hold the bed.

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:

1. Sentinel events;

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

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

Service;

4. Substantiated allegations of mistreatment, neglect, abuse or misappropriation of CNH veterans or property;

5. Elopements of CNH veterans pursuant to state regulations;

6. Infectious outbreaks;

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

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

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

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

1. a fall resulting in death or injury;

2. elopement resulting in a missing patient;

3. patient abuse confirmed or under suspicion;

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

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

6. death related to an unconfirmed or suspicious cause.

When an adverse event occurs involving a CNH Veteran which is not determined to be a Sentinel Event

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

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) Telephone Care Communications (TELECARE): For urgent same-day outpatient specialty care or for non-urgent scheduled clinic appointments/consultations, phone (713-794-8985 or 1-800-639-

5137). Monday through Friday, excluding holidays. If a same-day appointment is anticipated; please call as early as possible.

(b) Admissions Conference Call Systems phone number Phone #:713-794-7109

For non-emergency consultation or /evaluation for admission to the Michael E. DeBakey VA Health Care

System (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 # 713-794-7109

(d) 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, please call the RN transportation coordinator at 713-794-7605.

1. The CNH shall coordinate specialized transportation to and the from VA

Appointments, to include the VA Medical Center, VA Outpatient Clinics and Non-VA locations when the appointment is made by the beneficiary’s VA providers. Coordination may be made by making arrangements with the beneficiary family or others, when available and that desire to do so are capable of transporting the beneficiary. Sufficient notification to allow for planning is required. The VA does not insist that transportation be provided by the VA in all cases. If no other means of transportation are available, the

VA will be responsive to the CNH requests for transportation to these appointments.

Requests shall be made through the RN transportation coordinator at 713-794-7605 at least 48 hours prior notification for travel is necessary in order for the RN transportation coordinator to make arrangements in advance for nonemergent needs.

2. Contractor-owned, leased or contracted vehicle transportation, if utilized, shall be in compliance with applicable state laws and at no additional cost to the Government. CNH personnel’s Personally Owned Vehicle transportation of VA-beneficiaries is specifically prohibited.

3. The CNH is responsible for supervising and escorting VA beneficiaries housed at their facility whether the beneficiary is at the facility or has been transported to a clinic or other treatment facility, to the doctor, of the VAMC.

4. When a Veteran is sent to an outpatient appointment at the VA or community outpatient clinic (or admission exam where admission is not a certainty), the Veteran is still considered a resident of the Contractor’s facility and thereby remains the

Contractor’s responsibility.

5. The Contractor shall make a judgment as to whether the Veteran needs physical assistance due to disability or oversight due to confusion.

6. The Contractor will ensure patients who are considered high risk for wandering, elopement or are in need of physical assistance due to disability are accompanied by a responsible individual during absences from the facility for VA authorized appointments.

7. Family members must accompany Veterans to their VA authorized appointments.

When family is not available, Contractors are encouraged to use friends, volunteers or any other person who in the Contractor’s judgment can responsibly and capably provide the necessary oversight.

8. As a last resort, VA may be billed at the rate not to exceed $12.00 per hour for instances requiring the CNH to provide or purchase the service.

9. Preapproval by the VA is required in each instance where an escort is required.

Without such approval, the claim will be deemed invalid.

20. Charitable Contributions. The CNH will not solicit contributions, donations, or gifts from patients or family members.