Sol 36C26120Q1102 - Jewish Living.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 62

36C261-20-AP-2632

36C26120Q1102 09-23-2020

Jonathan D. Locklear 916-923-4552 09-27-2020

23:59

36C261

Department of Veterans Affairs

Network Contracting Office (NCO) 21

3230 Peacekeeper Way, Bldg. 209

McClellan CA 95652

X

623110

$30 Million

N/A

X

36C662

Department of Veterans Affairs

San Francisco VA Medical Center

4150 Clement Street

San Francisco CA 94121

36C261

Department of Veterans Affairs

Network Contracting Office (NCO) 21

3230 Peacekeeper Way, Bldg. 209

McClellan CA 95652

Department of Veterans Affairs

FMS-VA-2(101) Financial Services Center

PO BOX 149971

Austin TX 78714-9971

See CONTINUATION Page

The Network Contracting Office (NCO) 21 requires Community

Nursing Home (CNH) services for eligible Veterans within the San Francisco catchment area.

Procurement Authority Title 38 U.S. Code § 1720.

IDIQ Period of Performance: 10/01/2020 - 09/30/2025

Ordering Period I: 10/01/2020 - 09/30/2021

Ordering Period II: 10/01/2021 - 09/30/2022

Ordering Period III: 10/01/2022 - 09/30/2023

Ordering Period IV: 10/01/2023 - 09/30/2024

Ordering Period V: 10/01/2024 - 09/30/2025

See CONTINUATION Page

Gary Basile

Contracting Officer

36C26120Q1102

Table of Contents

SECTION A

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

SECTION B - CONTINUATION OF SF 1449 BLOCKS

B.1 CONTRACT ADMINISTRATION DATA

B.2 SCHEDULE OF ITEMS

B.3 SCHEDULE OF SERVICES

B.4 PERFORMANCE WORK STATEMENT

SECTION C - CONTRACT CLAUSES

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

2018)

C.2 52.216-18 ORDERING (OCT 1995)

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 52.232-19 AVAILABILITY OF FUNDS FOR THE NEXT FISCAL YEAR (APR 1984) 26

C.7 VAAR 852.212-70 PROVISIONS AND CLAUSES APPLICABLE TO VA

ACQUISITION OF COMMERCIAL ITEMS (APR 2020)

C.8 52.252-2 CLAUSES INCORPORATED BY REFERENCE (FEB 1998)

C.9 52.212-5 CONTRACT TERMS AND CONDITIONS REQUIRED TO IMPLEMENT

STATUTES OR EXECUTIVE ORDERS—COMMERCIAL ITEMS (JUN 2020)

C.10 MANDATORY WRITTEN DISCLOSURES

SECTION D - CONTRACT DOCUMENTS, EXHIBITS, OR ATTACHMENTS

SECTION E - SOLICITATION PROVISIONS

E.1 52.212-1 INSTRUCTIONS TO OFFERORS—COMMERCIAL ITEMS (OCT 2018)

E.2 52.204-24 REPRESENTATION REGARDING CERTAIN TELECOMMUNICATIONS

AND VIDEO SURVEILLANCE SERVICES OR EQUIPMENT (DEC 2019)

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 (JUN 2020)

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: Hebrew Home For Aged Disabled d/b/a San Francisco Campus for

Jewish Living

302 Silver Ave

San Francisco, CA 94112

POC: Rosabella Bray

Phone: 415-334-2500

b. GOVERNMENT: Contracting Officer 36C261 Gary T. Basile

Network Contracting Office (NCO) 21

5342 Dudley Blvd., Bldg. 209

McClellan, CA 95652

Contract Specialist 36C261 Jonathan Locklear

Network Contracting Office (NCO) 21

5342 Dudley Blvd., Bldg. 209

McClellan, CA 95652

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

[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

4. GOVERNMENT INVOICES ADDRESS: Vendors who bill electronically using the HIPAA-

Complaint claims transactions must submit claims through the VA clearinghouse, Emdeon, using payer

ID number 12115 for medical claims.

Vendor who are not able to use the HIPPA-complaint transactions are not required to do so. Supporting information from monthly invoices will be faxed to: 415-750-2284

Department of Veterans Affairs

San Francisco System Healthcare System

Attn: Community Nursing Home Program

4150 Clement Street

San Francisco, California 94121

B.2 SCHEDULE OF ITEMS

1. Rate Determination: The VA is seeking preferred rates, based on patient care need. VA rates are an all-inclusive per diem rate based on a percentage of Medicare or State Medicaid. The per diem rate(s) will apply throughout the term of this Indefinite Delivery, Indefinite Quantity Contract

(IDIQ). While the VA uses Medicare or State Medicaid rates as a reference, VA rates are independent of those payment systems and governed by the terms of this IDIQ. 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: Rates will apply throughout the term of the IDIQ and are reflected as stated percentages above the Medicaid rate(s), which are negotiated to cover the all-inclusive nature of the agreement and will not be negotiated. The rates will be computed and added to the published

Medicaid rate for each level of care item. California rates are located at http://www.dhcs.ca.gov/services/medi-cal/Pages/AB1629/LTCAB1629.aspx and Nevada rates are located at http://dhcfp.nv.gov/Resources/Rates/NursingFacilities/ .

For non-Medicaid nursing homes, the rates will be established/negotiated prior to award of the

IDIQ and remain applicable throughout the term of the IDIQ.

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

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

5. Private Rooms: A private room rate for clinical concerns such as communicable diseases or infections (e.g., MRSA, VRE), or other pertinent clinical needs may be charged above the negotiated RUG rate for that facility with prior approval by the VA CNH Coordinator or designated

VA staff. However, no additional private room charge will be allowed in the following circumstances: where the CNH only maintains private rooms; no double-occupancy rooms are available; and for ventilator-dependent patients with prior-negotiated rates.

6. 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.

7. Specialty Services: Payment for specialty services, such as but not limited to podiatry, dentistry, optometry or audiology, are not included in the per diem reimbursement rate. The CNH shall http://www.dhcs.ca.gov/services/medi-cal/Pages/AB1629/LTCAB1629.aspx http://dhcfp.nv.gov/Resources/Rates/NursingFacilities/ assume responsibility for arranging specialty care for Veterans by scheduling VA specialty appointments or requesting pre-authorization for either non-VA-Care or CNH in-house providers when such a decision is in the best interest of the Veteran and the VA.

8. Ventilator Care (if applicable): 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).

9. Escort Services (if applicable): Payment for escort services is not included in the per diem reimbursement rate. VA is not responsible for arranging or providing the staff for this duty.

Veteran, responsible party, payee or conservator may be contacted for payment

B.3 SCHEDULE OF SERVICES

Contractor shall provide Nursing Home Care services for eligible Veterans at contractor’s place of business within the Fort Bragg, CA area. All services shall be provided in accordance with the specifications, terms and conditions contained herein.

The guaranteed minimum, for the contract is one room for one veteran for one day. The maximum of the contract, inclusive of ordering periods, shall not exceed $6,900,000.00. The Government does not guarantee that it will place any orders under this contract in excess of the guaranteed minimum award amount.

(NOTE: The reference to the published rate means the date the rates are published and distributed, not the effective dates. In other words, if the rates are effective August 1, but they are not published until the subsequent March, then the rates for this contract would change in March.)

PERIOD OF PERFORMANCE: October 01, 2020 through September 30, 2025

ITEM

NUMBER

DESCRIPTION OF

SUPPLIES/SERVICES

UNIT PER DIEM RATE

BED HOLD

DY Reimbursed at Current State

Bed Hold Rate

RESPITE

Medicaid Daily Rate

HOSPICE CARE

Medicaid daily rate plus

REDUCED PHYSICAL FUNCTION,

BEHAVIOR & COGNITIVE

PERFORMANCE

DY Reimbursed at Current State

Medicaid daily rate plus

CLINICALLY COMPLEX

Medicaid daily rate Plus

SPECIAL CARE HIGH

SPECIAL CARE LOW

EXTENSIVE SERVICES

REHABILITATION

Medicaid Plus ___%

REHABILITATION + EXTENSIVE

SERVICES

B.4 PERFORMANCE WORK STATEMENT

A. Overview

1. Federal Acquisition Regulation (FAR) – Indefinite Delivery - Indefinite Quantity. In accordance with FAR 16.504, Indefinite Delivery - Indefinite Quantity, this is an Indefinite Delivery - Indefinite

Quantity (IDIQ) for the time from the “Award Date” and for a period of five years.

2. Services Rendered at VA Per Diem Rates. Upon acceptance of an authorized VA patient by the CNH, and if and when requested by the VA Contracting Officer, VA Contracting Officer’s Representative (COR) or other authorized representative, the Contractor shall furnish all supplies and services herein described, at the per diem rates specified in the Schedule of Items of this IDIQ. The VA Per Diem Rates are defined in the solicitation of this IDC. VA is obligated only to the specifically approved level of care for the specifically approved Veteran for the specifically approved time. Any adjustments or modifications to this obligation require written preauthorization.

3. Ordering: Orders for placement of Veterans in Nursing Homes will be made by the VA Contracting

Officer, the Contracting Officer’s Representative or other VA authorized representative and the placement process will be facilitated through the CPRS system.

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 San Francisco Health Care

System, in San Francisco, California 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 where patient medical/psycho-social care and well-being is provided for.

VA shall have the right to inspect the CNH and all appurtenances by authorized VA representative(s) to ensure that acceptable standards are maintained and that the necessary care to maintain the well-being of the patient is rendered.

C. Requirements (QASP Indicator #8)

1. General. (QASP Indicator #2) 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, safety 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 has developed quality of care standards utilizing CMS inspection criteria that are followed by VA CNH

Program Coordinators in their initial selection and approval of nursing facilities. See VHA Handbook

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

https://www.index.va.gov/search/va/va_search.jsp?NQ=URL%3Ahttps%3A%2F%2Fwww.va.gov%2Fvh apublications%2Fpublications.cfm&QT=CNH+Handbook&submit.x=0&submit.y=0

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 minimum 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 a room or private room only if clinically indicated, meals, nursing care, and other services or supplies commensurate with the VA-authorized level of care, without extra charge.

a. Nursing Home’s Responsibility for Patient Care: 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 anyway of the responsibility for the daily care and medical/psycho-social treatment of the veteran. This care includes times when VA beneficiaries are transported away from the nursing home to necessary medical appointments. Adequate supervision, care and treatment supplies (i.e. portable oxygen, dressing supplies, etc.) must be provided by the nursing home when a veteran is transported away from the nursing home to a medical appointment. This applies to clinical appointments at the VA Medical Center and Clinics (CBOCs) as well as medical appointments in the local community. For ventilator-dependent veterans who are receiving care in sub-acute faculties a RN must always accompany them when leaving the facility for appointments; the RN must be able to maintain the veteran’s airway and provide for a safe experience while away from the sub-acute facility. For cases requiring preauthorization, contact the CNH Program Coordinator.

b. Private Room: Beneficiaries or their representatives may elect to pay separately for a private room. If a private room is requested, the VA beneficiary shall be obligated to pay the difference between the standard rate and the private room rate. This agreement should be in writing https://www.index.va.gov/search/va/va_search.jsp?NQ=URL%3Ahttps%3A%2F%2Fwww.va.gov%2Fvhapublications%2Fpublications.cfm&QT=CNH+Handbook&submit.x=0&submit.y=0 https://www.index.va.gov/search/va/va_search.jsp?NQ=URL%3Ahttps%3A%2F%2Fwww.va.gov%2Fvhapublications%2Fpublications.cfm&QT=CNH+Handbook&submit.x=0&submit.y=0 between the facility and the beneficiary or their legal representative, with a copy to the COR.

If the contractor elects to place a VA beneficiary in a private room without a formal request, then the VA is only obligated to pay the rate for the beneficiary’s current level of care under the terms of this contract.

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 or the veteran.

3. VA Authorizations. Authorization for nursing home care will be provided by the VA on VA Form 10-

7078, “Authorization and Invoice for Medical and Hospital Services.” Each authorization period will be noted on the VA Form 10-7078 with a beginning and end date. Any extension to the original authorization period, regardless of the number of days, requires a new VA Form 10-7078 and needs to be reviewed, and approved by the paying VA Community Nursing Home Program.

4. Medicaid Based Rates. The current Medicaid rates are used as a basis for determination of VA per diem rates. The VA per diem rate will include customary and usual medical care, medications, laboratory, x-ray, daily medical supplies (i.e. catheter supplies, bandages, etc.), nutritional supplements, and therapy/ies authorized by VA, unless otherwise specifically exempted.

a. 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 upon admission to 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 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).

1) Provider visits: As indicated in Section C, 1 above - Primary care physician visits are required to take place at a minimum of one (1) per month. These visits are included as part of the per diem reimbursement rate, and in no case, are to be billed separately or billed to the patient or his/her family/representative. If a patient’s condition requires more frequent Primary Care Physician visits or requires specialty medical evaluation and treatment (i.e., wound care M.D. specialist) prior authorization from VA is required. Additional provider visits will be reimbursed at the prevailing

Medicare/Medicaid rate.

b. Rehabilitation Criteria. All therapy provided under this IDIQ will be individual therapy, rather than group therapy, unless otherwise ordered by the authorizing VA facility. Therapy will require pre-approval by VA before services are provided. Medical Restorative criteria will be used for physical therapy, occupational therapy, and speech therapy. Therapy must be skilled, relate to safety and be restorative according to Medicare criteria. Retroactive claims will not be approved – NO EXCEPTIONS. Please consult your VA CNH Program Coordinator for authorization submission instructions.

1) Description of Rehabilitation 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 rational 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.

2) Rehab authorizations for low RUG Scores: When rehabilitative therapy frequencies do not trigger a high enough RUG score to issue the appropriate reimbursement for rehabilitative therapy, these services may be approved as an ancillary service at the prevailing rate providing preauthorization from the CNH Program Coordinator has been received. Documentation will describe objective measurements which, when compared, show improvements in function, or decrease in severity, or rational for an optimistic outlook to justify continued treatment at the lower frequency.

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

5. Emergency Care; Financial Responsibility; Advanced Directives. In emergencies, nursing home staff will utilize the 911 local emergency systems as it would 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.

6. 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 if they are conducting health care on VA’s behalf. The CNH care program qualifies as a medical service, so no BAA is required.

7. State Licensure/Liability/Certifications; 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/sub-acute facility or residential care facility. Changes in the status of the licensure will be immediately reported to the Contracting Officer Representative. The CNH must also maintain current

Liability Insurance and current Center for Medicare and Medicaid Services (CMS) certifications. The VA will monitor the professional care and administrative management of services provided to VA beneficiaries under this IDIQ, 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 IDIQ, including VA’s on-site inspection and monitoring. The VA Contracting Officer and Contracting Officer’s Representative shall make all final determinations as to the Contractor’s reasonable cooperation with VA and compliance with these requirements.

8. Corrective Action Plan (QASP Indicator #3). 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.

9. 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 IDIQ award and compliance with all applicable Federal, State and local regulations. The administrator of the CNH is required to notify the VA Contracting Officer’s Representative 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 IDIQ became effective. The VA Contracting Officer’s

Representative 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. This information will be reported to the Contracting Officer. These changes may include but are not limited to:

a. Interior changes requiring VA approval. Some examples of facility changes that require

VA Contracting Officer’s Representative 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.

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.

10. 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.

11. 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 #6-#7). 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 the 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 notification must be performed within 72 hours of admission of the patient to a non-Federal facility and notice of any veteran death within 24 hours or immediately on the first business day after a weekend or holiday by faxing the approved form to the fiscally responsible VA Medical Center.

1) Upon discharge from hospitalization the CNH must submit a copy of the discharge summary to the CNH Clinical fax line (415) 750-6668.

b. In the event of a death of any VA covered veteran, the CNH staff will immediately assemble, inventory, and safeguard the patient’s personal effects. Any funds, deposits, and effects left by the VA patient upon the premises of the CNH shall be delivered to the person(s) entitled the laws currently governing disposition of funds and effects left by skilled nursing home 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.

d. 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.

12. Bed-Hold: For re-hospitalizations or therapeutic passes, VA will pay a bed hold. The CNH is responsible for requesting all bed holds and, if applicable, bed hold renewals. 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. If the

Veteran chooses to return to the CNH from a hospitalization under another form of coverage/insurance

(Medicare/Medicaid), or if the Veteran chooses not to return, or is not permitted to return to the facility, the total VA bed hold reimbursement will be revoked. Absences of fifteen (15) consecutive calendar days or more, whether in a VA Hospital or in a non-VA Hospital require a new authorization.

a. Hospitalizations: If the CNH facility is requesting bed hold reimbursement the request must be submitted immediately. Hospitalization Bed Holds are approved at five (5) days maximum per episode and can be renewed up to 15-days maximum when in the best interest of the Veteran and the VA. Bed hold extensions beyond 15-days are considered on a case by case basis. The patient must present with significant clinical acuity along with limited placement options to be considered for review. Additional review by the SFVA

GPEC Associate Chief or SFVA GPEC Medical Director is required.

b. Therapeutic Leave/Home Visits: Bed holds for Therapeutic Leave/Home Visits may be authorized by the CNH Program Coordinator based on individual patient needs and safety and must be pre-approved. Retroactive requests for Therapeutic Leave/Home Visits authorizations will denied.

13. Reportable Events (QASP Indicator #4). VA requires CNH’s to report to the CNH Program

Coordinator any of the following events within 24 hours or immediately the first business day after a weekend or holiday:

- sentinel events (see below)

- change of ownership of the CNH

- change of Nursing Home Administrator or Director of Nursing/Director of Nursing

Service

- substantiated allegations of mistreatment, neglect, abuse or misappropriation of CNH veterans or property

- elopements of CNH veterans pursuant to state regulations

- infectious outbreaks

- resident to resident or resident to staff altercations involving a CNH veteran resulting in any injury that is other than minor

- any time there is a substantiated complaint investigation conducted by a State oversight agency

- any other adverse events

a. 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

6) death related to an unconfirmed or suspicious cause

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

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

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

b. Suspend placement of veterans in the CNH;

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

d. Not renew the IDIQ; and/or

e. Immediately terminate the IDIQ.

15. VA Staff Access to CNH Records (QASP Indicator #5). All medical records (paper and electronic) concerning the VA Beneficiaries’ care in the CNH will be readily available to all authorized VA staff including clinic specialists, nurses, and social workers. VA CNH Program Nurses and Social Workers will require remote access to the CNH’s electronic records. 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. 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) The plan of care medication administration record (MAR), and treatment administration record (TAR)

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

4) Medical practitioner orders which are signed and dated;

5) Allergies;

6) Person to contact in an emergency situation;

7) Name of attending medical practitioner; and

8) Advanced directives if available.

16. 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. The VA requires that the CNH follow CMS regulations for maintaining and retaining records when there is no requirement in State law.

17. Routine Ancillary Services are included in the per diem reimbursement rate. The CNH will assume responsibility for providing ancillary care for veterans (e.g., Dentistry, Optometry, Podiatry, etc.).

a. All Podiatry that is reasonably considered to be basic or routine* is included in the per diem reimbursement rate. At no time is the patient or the patient’s family/representative to be billed for this service. The patient is expected to receive routine podiatry care every other month.

All other medically necessary and non-emergent treatment of foot diseases/disorders/injuries must be received at patient’s VA Medical Center.

*Basic and routine Podiatry care consists of:

- Evaluation of the feet

- Cutting or removal of corns and calluses

- Trimming, cutting, and clipping of nails

- Hygienic or other preventive maintenance, including cleaning and soaking the feet

b. Dentistry (basic Oral Care) and, Optometry (Vision Care), and Audiology (Hearing Care) that is reasonably considered to be *basic or routine is included in the per diem reimbursement rate.

At no time is the patient or the patient’s family/representative to be billed for these services.

The patient is expected to receive routine care at the same frequency as a Medicare/Medi-Cal covered patient.

* Basic and routine Dentistry (Dental/Oral Care) includes:

- Oral evaluations, routine cleanings, x-rays and fluoride treatments

* Basic and routine Optometry (Vision Care) includes:

- Screening for eye disease, and/or updating eyeglass or contact lens prescriptions

* Basic and routine Audiology (Hearing Care)

- Hearing and balance assessment

1) All other medically necessary and non-emergent treatment of diseases, disorders, and/or injuries must be received at the patient’s VA Medical Center. For patients who are unable to receive these services at their local VA Medical Center due to their significantly acute medical or cognitive status, pre-authorization is required.

Documentation indicating their presenting status and their need for the additional service (a and b) must be made available for review and determination. These ancillary services include rehab at frequencies which do not trigger a RUG score.

2) Patient may also choose to receive the above (a and b) routine and basic services at his

VA Medical Center. The CNH will assist the patient with arranging necessary appointments.

c. Routine Medication Review: Includes routine pharmacy review and basic and routine psychotropic medication review.

18. Travel escorts are the responsibility of the servicing CNH and require preauthorization through the

CNH Program Coordinator.

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

20. Respite Care: Respite Care will be reimbursed at the VA base rate. The purpose of this level of care is to provide temporary relief to the primary care giver to help the veteran to continue reside in their primary residence for as long as possible. It is designed to accommodate referrals with minimum care needs.

Patients with more complex care needs may not be appropriate for this level of care. Inpatient CNH respite reimbursement is provided at the VA’s discretion and must be pre-approved by a VA authorized official.

Respite coverage is limited to 30 days per fiscal year. No extensions will be granted at any time. No exceptions to this clause and the restrictions noted below will be granted.

a. No rehabilitation services, skilled services, 1:1 sitter or escort services, transportation services or ancillary services of any kind will be reimbursed during an episode of respite coverage.

b. The cost of medications during respite stays will not be reimbursed. Patient medication issuance or costs must be managed between the patient and the nursing home prior to the patient’s respite admission.

c. Inpatient respite discharge plans including discharge transportation must be pre-arranged between the patient/patient’s legal representative and the nursing home.

d. The VA will not be responsible for uninsured respite stays beyond the 30-calendar days.

21. Hospice: Reimbursement for inpatient CNH hospice care requires pre-authorization. Approval will only be considered for established VA patients who meet hospice clinical criteria, are enrolled in hospice services, and in conjunction with VA provider review and concurrence.

a. This level of coverage is limited to a 6-month period after which additional VA Provider review and re-certification will be required for additional coverage approval. It is the responsibility of the CNH facility to request coverage extensions beyond the initial 6-months.

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

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

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

22. Specialty Services. CNH is required to arrange VA specialty clinic appointments, including psychiatric care or behavioral health therapy, when consults or treatment are needed, or in cases where patients who are medically unable to travel to a VA medical center or clinic, CNH will request pre-authorization for non-

VA treatment in the local community.

a. Pre-Authorizations: All pre-authorization requests should be faxed to 415-750-6668, the

CNH Program Office.

b. Telephone Care Communications Systems (TCCS): For urgent, same-day, outpatient, specialty care or for non-urgent scheduled clinic appointments/consultations, phone (800) 733-

0502. 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.

c. After hours, weekends and holidays: Registered nurses are available to provide enrolled veterans with free, confidential health questions 24 hours a day, 7 days a week through our toll-free telephone care program at (800) 733-0502.

d. Transportation: Medically necessary transportation to and from VA medical appointments will be authorized by the paying VA Healthcare System. Travel can only be arranged for authorized CNH patients and only when requested by the CNH facility with at least 48 business hours advanced notice. For initial transportation requests, contact the CNH Program

Coordinator/Social Worker.

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

24. CNH Billing (QASP Indicator #9). Invoices for IDIQ care and ancillary services shall be submitted promptly to the authorizing facility by the 15th calendar day following the end of the month in which services were rendered. Items not pre-authorized will not be processed. The CNH will promptly notify the

VA CNH Program Coordinator regarding any change in Veteran status: discharge, transfer, against medical advice (AMA), hospitalization, death (use form titled Nursing Home Notification of Discharge or Death and fax to CNH Program) and/or any changes in payer source and any inability to complete timely billing.

All invoices must include the full name and address of the CNH and shall reflect the patient’s name, social security number, number of days billed, and agreed upon rate (s). Failure to include this information may result in delayed payment. The current CNH Billing Cover Sheet can be obtained from the VA Fee

Basis/Purchased Care Department.

a. Pre-approved services billed by CMS procedures or CPT codes: All services which are pre-approved by VA in addition to the all-inclusive per diem rate must be billed according to

CMS procedures or CPT codes. The CNH will be reimbursed based on local guidelines and

VA pricing schedules.

b. High cost drugs: All medications are included in the per diem rate, except for high cost medication including but not limited to HIV and Hep C medications. Medications, which comprise more than 8.5% of the monthly per diem rate are excluded from the rate(s) established here. The cost of any high-priced drugs will be determined or priced using the Average

Wholesale Price (AWP) of the drugs, plus a transaction fee of 3% per month. All calculations will be made monthly. When a high cost drug patient is identified, VA staff must be advised promptly to establish an appropriate course of action, which may include the provision of the medication by the VA. It is recommended that the accepting CNH request sufficient quantities of medication from the institution that the patient is being transferred from for the convenience and the ease of transition of the patient.

c. Invoices: Invoices will be sent on the CMS-1450 (red invoice). The invoices must include the same information as provided to Medicare. Payment will be made monthly, thirty (30) days in arrears, following receipt of a properly prepared invoice. A properly prepared invoice shall include the RUG level and assessment reference date. All services provided must be itemized

(listed separately) on the invoice. Separate invoices will be submitted for each Veteran approved for services under this agreement.

d. Invoice Correction: Corrected invoices must be submitted for additional payment of any VA pre-authorized ancillary costs or changes to the original billing. Items not pre-authorized will not be processed. All corrected invoices must include all items that are affected by the change and should include the CNH corrected claim form (available from VA Fee Basis/Purchased

Care.

25. Minimum Quantities; VA Payment. It is impossible to determine the exact or estimated amount, which will be expended under this IDIQ. No 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 recipient enters the

CNH but not the day the recipient leaves a CNH unless…